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r <br /> Burnett Counrty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -U0 Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> ,V- 4-f/-4488-x7254 N R <br /> � �� w-GS/-Gf4G-/298 a <br /> OWNER ULB.N �dNNA 1 .Cw/iiE10 zp TELEPHONE <br /> LlAsiv .4aeat64- 23928 Gv�.e�o.srv.�d%�ee�v, <br /> HOME ADDRESS 78/ i/A446 � m e.4��i f� ? <br /> ���i <br /> r � <br /> EMERGENCY/FIRE NUMBER ?39� ROAD NAME O <br /> i9-.Z3 4cP/-36/ V i!- 738-.P/7t✓ 4e err 1 <br /> P <br /> LEGAL DESCRIPTION(see tax receipt)a,38 / m <br /> DWELLING/BUILDING Z GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ O <br /> TYPE OF PERMIT(S): ° <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ r n � <br /> N' <br /> STRUCTURE/ADDITION USE: ozz �C•e,.� Ll k3�1V W�(/7 .S <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) rn <br /> m <br /> BUILDING CONTRACTOR: '- <br /> (D <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR (D <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) C <br /> n a <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 0 m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). c <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. <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO v <br /> BUILDINGS,ROADS,LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. o N <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. I o <br /> o t <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN O <br /> NEEDED. T <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z <br /> CONDITIONS OF PERMIT: <br /> 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. d <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 /> S TBACKAREA. <br /> 5. ' 5 <br /> r1��c�rq ��/N�c-(c' l/,gn'c yr,� Sy7li c�Lr•e� �1/ <br /> CD 0 D q�EE; <br /> � CC6, L D <br /> CD <br /> 7. Q- 6ell Zo = v� <br /> A <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my " C C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize CD m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> 0 : <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 /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> CD <br /> Z&�- (D <br /> SIGN HERE 7-.2q <br /> si r ner wilding contrac rV , (date) <br /> (/ <br /> ZONING ADMINISTRATOR Q' <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> t% <br />