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Burnett Cotlhty 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator v0 Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> N <br /> OWNER /�V l Vi TELEPHONE <br /> l �^y C�, fu <br /> MAILINGADDRESS �� �a 360 t'pJ1�,� . �1 1 L� v O <br /> CD <br /> T ` 0 m <br /> PROPERTYADDRESS C ,Qct S �J�/ ��C���pt�^� (Aut . <br /> LEGAL DESCRIPTION(see tax receipt) S. 3 I <br /> e �• h 1 <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE 9 ADDITION ❑ U) <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT SUBDIVISION c <br /> ❑ G <br /> STRUCTURE/ADDITION USE: T V ' w /^Lib f'o C (vv 0 Q� <br /> e/Cab' ; Commercial usiness;Bed oom; Deck;etc.) r� 0Q) <br /> 1 <br /> BUILDING CONTRACTOR: J �A*Lo� — <br /> d' <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8Y:X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> .Zl N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <br /> n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m (/ , 3 <br /> CEG ( <br /> CENTERLINE OF ROAD,(C)BUILDING(S)S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. p 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. LIQ 00 <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. l N J <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONT C.,THE PLANS 0 CT <br /> MUST BE SIGNED AND DATED BY THE OWNER. o c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATI N MAY <br /> NEEDED. p 2Su <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. J MAY Z 9 Z �l <br /> CONDITIONS OF PERMIT: P <br /> NEL <br /> 1 ISSUANCE.DRIVEWAY <br /> MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIITTUR N NG UNT' �/ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. �, C <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. I k <br /> 5. <br /> m oni ru rDi O Da 0 -0 <br /> 3amWacDA <br /> 6. CDCNNo = 3 <br /> 7. Z N m' ° <br /> o n z <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my O <br /> �J <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of p,� d n fA C <br /> PP (including Yaccompanying ) g v' <br /> all information contained in this application Includin an schedule and I further declare that I recognize io � o m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- V m <br /> sue a permit. I further accept all Iia ich may be a result of the County of Burnett relying on this information I am m <br /> providing in this application. I a ee to a 't coun officials charged with administering county ordinances or other 01 <br /> P 9 pP 9 P tY 9 9 tY . <br /> authorized person ave access t Oeabove escribed premises at any reasonable time for the purpose of Inspection. : . o <br /> M m <br /> SIGN HERE d' <br /> (signature of owner or buifdin c tr oC,' n <br /> (date) -SCJ <br /> ZONING ADMINISTRAT <br /> fA fA fA EA N <br /> N (T NNOO <br /> ^ (11 O0 (T OO <br /> TOWNSHIP PE ITS MAY BE REQUIRED /V�} <br />