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Burnet County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator �v-0o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 4 <br /> OWNER p (� �w kAl' q,-)-q5 383 G <br /> —�D41,ae•L P d_ 13 ,�Q l.�a TELEPHONE �.Iq Jsf I83`t< O <br /> m <br /> HOME ADDRESSn Q 0 p� <br /> 5?9�4 n /Rf c.cae� O�ItaM <br /> r rn <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> O. 3 s64/b!7 S - /T4t/ n!t; W <br /> LEGAL DESCRIPTION(see tax receipt)©S 9oDkOT /a a CSM V S' P/,n L Gdv 4.4o r V r <br /> a_ <br /> DWELLING/BUILDING ® GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ElPRIVY ElTYPE OF PERMIT(S): Cl) <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> STRUCTURE/ADDITION USE:2x_944" 3 <br /> (Home/Cabin;Commercial Business; Bedroom; eck;a c.) y <br /> t ' <br /> BUILDING CONTRACTOR: R„, � ,L�„ �,,.3,� � � � L <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'%X 11 SHEET OF PAPER. ANY INCOMPLETE O <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 6.eGe 3. C <br /> DIRECTIONS FOR PLOT PLAN DRAWING, (AERIAL OR TOP VIEW) <br /> s IY1u Isf N5 ✓' o r4 <br /> -n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATEA <br /> m m <br /> NORTH(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. ( _ Z <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO I c <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. 1 l <br /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHENq o, <br /> NEEDED. 4 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW, ) <br /> CONDITIONS OF PERMIT: P <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. Q <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. �e{zu w r+I I s ct Il S f�-u.c-Eur-e-3 r)s;:-{, fror- A l l ft-w Ie- l u)lhe.Y'S <br /> 6. _ /U o C--1k4t.ln.%\ 1:4- 7rSi 111 w CKI w so�i U� G(�cc/m p� Avlh je/'S i 3 0 a M <br /> V m C y " >> 3 <br /> 7. ca. <br /> Q) .0 <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of d m c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- p <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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other (vim <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. 1 <br /> o_ m <br /> SIGN HERE 3_ -9Cj v� <br /> (sl re of owne ullding contractor) (date) ` <br /> ZONING ADMINISTRATOR <br /> � �o�aoo <br /> TOWNSHIP PERMITS MAY BE REQUIRED0 0 0 0 0 0 0 <br />