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Burt ett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator T o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> 0 (1 . <br /> r �^ � aV <br /> OWNER Leerli a AcaLi6LL) nit= Aoe_ TELEPHONE/,/2- <br /> HOME ADDRESS tCj,jJ Ayz so �/ T�9� 1�� MN `J'�/ ° 9 <br /> EMERGENCY/FIRE NUMBER ROAD NAME ILl SOA/ ~lam <br /> LEGAL DESCRIPTION(see tax receipt) <br /> PCS T/�-LSfJV (Il <br /> L# z /9, o7s, VA00o L0 <br /> Ce ° <br /> TYPE OF PERMIT(S):DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION 0�3 `c <br /> Q: <br /> w' <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> ca <br /> STRUCTURE/ADDITION USE: at <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) v _r <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR 3 ~ <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). N <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m 3 <br /> 33 <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, CX11 Z <br /> STREAM OR RIVER. ° <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILD- <br /> INGS,ROADS, LAKE, LOT LINES. �J <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. m' <br /> v � t <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BEq E <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: ? I <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.,ALLOWEDe <br /> THE OHWM OF LAKES, <br /> PONDS, V UNLESS SPECIFICALL PERMIITTTTTED..'n F' <br /> 5. ` � f.' q�����/Cs / cy� � psi/ <br /> � -an� O o -0 <br /> // ry^I _ 3 <br /> 6. 6tVS% lore on 4e Sher <br /> arca a �, h�t�lc�t�( f SPe�e 2SfAY 4 199 <br /> > > 3 <br /> o : <br /> ec <br /> 8110A —c''• € m <br /> I declare that this app cation (Including any accompanying schedule) has been nd tothe.best of my ZS c 6 <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am respo�.��� nd accuracy of <br /> all information contained in this application(including any accompanying schedule)ana�lll�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 MCI m m <br /> providing in this application. I agree to rmit county officials charged with administer' er <br /> authorized person t have ac s th ove described premises at any rea pn. T <br /> SIGN ERE <br /> gna ure f ner i contractor) APR <br /> NI <br /> ZONING ADMINISTRATOR 40 46'40 10 <br /> URNE NNS NNpp <br /> B 1v oN,NG � $C, C, 0 0 <br /> /OWNSHIP PERMITS MAY BE REQUIRED z o 0 0 0 0 0 <br /> J� <br />