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Burnett County 7410 Co.Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator 71 6) z <br /> APPLICATION FOR LAND USE PERMITS 3. (4 <br /> l C. pETERSOd <br /> OWNER ,✓RGKf- ,q.T-yE-R/NE TELEPHONE/S) 1169_ 7741 o <br /> o� <br /> HOME ADDRESS 1#9 6 Sall S s CCHA L E T ji .p SHELLCD <br /> LAKE fi�/j sy$7J v �,° <br /> n r <br /> EMERGENCY/FIRE NUMBER ILI96 ROAD NAME Su//SS <br /> LEGAL DESCRIPTION(see tax receipt) ` m <br /> CD <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION ElPRIVY El o' <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNITEl <br /> SUBDIVISION a <br /> STRUCTURE/ADDITION USE: 36 ' X ,30 ' /DOLE 6.4 P, 1`1 o' <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) Cn <br /> m <br /> BUILDING CONTRACTOR: S �✓E �OD/-e Er <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR '3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> O — <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> n C. <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n 33 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m r? <br /> NORTH(N). <br /> n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. �o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO <br /> BUILDINGS,ROADS,LAKE,LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 3 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> o � o ' <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN q ° �V <br /> NEEDED. 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z f <br /> CONDITIONS OF PERMIT: P V <br /> i <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT rJ <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 1 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY 7�• <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER C <br /> SETBACK AREA. <br /> 5. <br /> M 0 r- 0Daov <br /> 6. k 3 nm <br /> CL <br /> N C N y <br /> CWD <br /> 7. Z : <br /> O <br /> Cn <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my �j c 10 <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofm 0 c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize CD <br /> C m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- O <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information I am m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized pe n to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> m : <br /> m <br /> SIGN HERE S l J g q $ <br /> (sign ure of owner or b Ing contractor) (date) <br /> ZONING ADMINISTRATOR . . . . . d, <br /> 'A 40 to Vi w fns <br /> N Pi MNN V1 fn <br /> U1 N O N (n O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED ° 0 0 0 0 0 0 <br />