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cT <br /> Burnett CoLnty 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator � Z <br /> APCATION FOR LAND USE PERM)TS 3 <br /> PW <br /> ,�07 i� <<r�� S'G/ O�•aaoca . /r`l/V 3-s�6o � �J <br /> Q � /S0�)gyp/6/7-2.Lj? � o <br /> OWNER 'L /�I'1 TELEPHONE ! ��_S/O Ole+ _�Q o eve <br /> HOME ADDRESS zd leea C p� <br /> m <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> Pd CTC- �S L o <br /> X023 7- t/v /� <br /> LEGAL DESCRIPTION(see tax receipt) CO CI m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION PRIVY ElI o <br /> TYPE OF PERMIT(S): V C 0 <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> \5. <br /> STRUCTURE/ADDITION USE: a <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: ©GZ�/7e✓— l� _ <br /> m <br /> T <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR CD <br /> I <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n 3 <br /> O <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m` <br /> n n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. a z n v -b <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m A <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. o <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. IN 13 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o Q ' <br /> ° f Y <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN I <br /> O <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z SU <br /> CONDITIONS OF PERMIT: ° <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. C> <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY 1 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. Ze� rnent U ey( 4I <br /> �� / My0g > 0 > 07 <br /> 6. Sem �GQ �jL�1/ QP" 0 3 a. OD 0ac5 ;u <br /> mC y N O Ei 3 <br /> 7. Z N N O : t0 <br /> m <br /> I declare that this application (including an accompanyingschedule has been examined by me and to the best of my �j A <br /> pp ( 9 Y ) <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of w 0 c <br /> all information contained in this application(including an accompanyingschedule and I further declare that I recognize m ` m <br /> pp ( 9 Y ) (D <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 m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> m <br /> ID <br /> SIGN HERE <br /> (signature wn or bui i ontractor) (date) Q j <br /> ZONING ADMINISTRATOR (��r <br /> Pj <br /> TOWNSHIP PERMITS MAY BE REQUIRED a <br /> a <br />