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Burnetf County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v 0 Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> Wom, 651 —205-8249 W <br /> 5}1P40fst A. SFE'I� �Fo met (F31 .-730_qq 1(p <br /> OWNER K>?JST7 N t. O.I.tHS Ot-! TELE HONFC: r4: r)IS &A%-2- <br /> HOME <br /> A33 <br /> HOME ADDRESS 377 QEIVDIZ`�'Pl I�IIL Wk —� I,I�Of�B1W IVI� 5512 v � <br /> r m <br /> 0 <br /> EMERGENCY/FIRE NUMBER 28522 ROAD NAME SLUJaMEY LANE <br /> 5Et. O/TN 40/IL 17/ 0 <br /> LEGAL DESCRIPTION(see tax receipt) F,I NC.ESS PINE 51.10U-5 LDT5 "t 1 O y <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ ) 0 <br /> TYPE OF PERMIT(S): n vCrINk <br /> FILLING/GRADING ElCAMPING UNIT ElSUBDIVISION El0 ,^ CL <br /> STRUCTURE/ADDITION USE: 71U6411ff CO <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) ur <br /> m <br /> BUILDING CONTRACTOR: Z>A IU 40QA EM G?- <br /> � � I <br /> v <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. n <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> -nO Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. a m 1 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <br /> C 0 <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 <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 1 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. <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' 0 1 <br /> v O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN Ct <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z <br /> 0 <br /> CONDITIONS OF PERMIT: 1 <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 AR A. <br /> 6. �' 3 as 'X-ay. � <br /> mCMW <br /> N !" o53 <br /> 7. o <br /> Cn i i m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of 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 l7 <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 u <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other Qt a m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. `+ <br /> m <br /> SIGN HER <br /> (S-1311 ureef ero uIl co or) (date) <br /> ZONING ADMINISTRATOR <br /> cn cnwf»f»fn� <br /> N N fn N N fn N <br /> VI VI O VIN O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 <br /> 0000000 <br />