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oYG67Y? <br /> 13urnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v O / Z <br /> APPLICATION FOR LAND USE PERMITS 3 ° <br /> r <br /> y O <br /> y <br /> OWNER G cra l I L K p re I TELEPHONE G s' _7, 0 O3,f s <br /> HOME ADDRESS 'a9'�'� tbwpr4 S♦ 1►IgDI� WOiI f /�t_ N S-2 0 2 � 9� <br /> 0 m <br /> EMERGENCY/FIRE NUMBER g S+ �� ROAD NAME S ub6 <br /> L0+s I,1.3, 4 *T"3a„ c Is La or- a' <br /> LEGAL DESCRIPTION(see tax receipt) ( 1/ 11 1 1 r <br /> DiyiSiOh oT DwIl ,S LgKe. , 84ri%d� C04„4y , W = v <br /> X <br /> 0 <br /> DWELLING/BUILDING 1:1GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ILV PRIW ❑ y�o <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ c <br /> 11 `1 p rr �11 r 11 e1._ <br /> STRUCTURE/ADDITION USE: �hd Al-V ReoT Fk <br /> Oh TOp OT IMIA-1 a STh 44r(,,, o <br /> C (Home/Cabin; Commercial Business; Bedro ; Deck;etc.) y <br /> BUILDING CONTRACTOR: S L,f 2. <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 /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p ' <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m 9 <br /> NORTH(N). C 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 03 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF `0 <br /> Pr <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. lz�- c <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO C <br /> BUILDINGS,ROADS,LAKE, LOT LINES. * Q <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. p , <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. c 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHENq 0 <br /> NEEDED. o _ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT O <br /> ISSUANCE. ^� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 1 ^)tv <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. <br /> 6. 3 � m <br /> n <br /> a : ECvNi `" oS � <br /> 7. Z =j <br /> o ? <br /> Q) m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Crp <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m 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- d 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 y <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. <br /> m <br /> SIGN HERE �, 5ZI 7 <br /> m <br /> ( gn ture of owner or it g contractor) (date) <br /> ZONING ADMINISTRATOR <br /> 4a454 49�� <br /> N NNNN(T <br /> (rt VI O (rl V7 O <br /> TOWNSHIP PERMITS MAY BE REQUIRED �lI l 0 0 0 0 0 0 <br />