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e `-'rqc� <br /> Burl,etttounty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - " O o <br /> APPLICATION FOR LAND USE PERMITS . <br /> UT 0 <br /> a � v <br /> OWNER �EE } �t`rjfLEF/J / VSC}�L TELEPHONE((51'LIOrI�_ pt40 J o <br /> '4661 ASPE-V"n QIa C CIR ),01031 80,o7lE RPAI) CD o <br /> HOME ADDRESS F-A AAS /�f l_ l�2 <br /> �7 a <br /> 0 <br /> /� <br /> EMERGENCY/FIRE NUMBER /� p O 3q ROAD NAME 89021E 0AQ O o <br /> LEGAL DESCRIPTION(see tax receipt) 7 �.-7 CroV Ler � SEC-p �� �\ )� W J \ <br /> T <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE Y ADDITION ❑ PRIVY 4 <br /> TYPE OF PERMIT(S): _ ^ <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ _J < V <br /> STRUCTURE/ADDITION USE: GAQfrF <br /> (Home/Cabbin; Commercial Business; Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: Gro12G r7AUJ,K d <br /> k <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. p <br /> 71 N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> T <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> Aa <br /> C 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <br /> a <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. ° <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO d <br /> BUILDINGS,ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N 04 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 0 f <br /> MUST BE SIGNED AND DATED BY THE OWNER. f -� <br /> o <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN M. <br /> ° <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o W <br /> CONDITIONS OF PERMIT: <br /> 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. Q <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. This structure to be used as private residential x v 0 r- a v D o v <br /> ` �, garage/storage only. Not to be used for human 0 M. 3 a 8 Ox a z <br /> 6. Sem V 1�Y�`� ��7 habitation. Z N o " ; 3 <br /> 7. o -n� .0 <br /> - cn : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G) 2 A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of n c A <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- <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 <br /> CD <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> 1 m : <br /> m : <br /> � o I <br /> SIGN HERE ( P_e_- V <br /> (signature of o or or building contractor) (date) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />