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�)Zc ->q2/' <br /> Burg-tt County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 G) Z <br /> APPLICATION FOR LAND USE PERMITS 315. <br /> OWNER ��L'�i�e�/V�'e' �fZ<�Pl�v G l�o�Lyy�FLy EPHONE e'IX— S77iZs? 0 <br /> HOME ADDRESS <br /> ?J <br /> m <br /> EMERGENCY/FIRE NUMBER �=✓c7 �� ROAD NAME e�� <br /> Le eot;43 S�rfe,; Ry T-yD WR /jr-40 I\ <br /> LEGAL DESCRIPTION(see tax receipt) Towx o F 09 cv<�O^! � 1 y <br /> CD <br /> �y 1 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE Idl ADDITION ElPRIVY El !� fn 0 <br /> M <br /> TYPE OF PERMIT(S): - )Q <br /> FILLING/GRADING ❑ CAA�ING UNIT ❑ SUBDIVISION ❑ n <br /> C/�-' m. <br /> N <br /> STRUCTURE/ADDITION USE: JAoe 4a o <br /> (Home/Ca ; Commercial Business; Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: ic- 6-,' <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C1 m I .0 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m :" <br /> NORTH(N). a <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. P, <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. Go So <br /> O 9 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN q <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> 0 <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. Vo r 58l <br /> C -UaW o 0 <br /> 6. m ' m <br /> D mC� !" o � 3 <br /> 7. N �1< <br /> _ rn : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of o c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m 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 person to have ac ess to the above described premises q4 any reasonable time for the purpose of inspection. <br /> SIGN HERE <br /> gj(8,11' atu of ow er~Kg coNr <br /> actor) (date) <br /> ZONING ADMINISTRAT . . . . . . to <br /> 40 <br /> N N N N N N f T <br /> Vt fJ1 O V7 ut O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />