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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 <br /> Office of APPLICATION FOR LAND USE PERMITS Hing Administrator 0 0 0 <br /> 3 <br /> ir O <br /> OWNER <br /> dl / -+QGD/77 TELEPHONE 61a <br /> HOME ADDRESS �'/6 Jr 6,0 T4O a <br /> Ave' IV9 7Ls SS-4w <br /> EMERGENCY/FIRE NUMBER agyq ROAD NAME <br /> f�. <br /> r <br /> LEGAL DESCRIPTION(see tax receipt) �r.0 617, �� AIR () <br /> �,�, 7 T.SCo� 63, �aT�l lr 'J m <br /> W e <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ o <br /> TYPE OF PERMIT(S): j I <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: <br /> o' " <br /> ome/Cabin, Commercial Business, Bedroom; Deck;etc.) ' <br /> �y <br /> BUILDING CONTRACTOR: AJ0R-77iler-A 00 0HZ,0s °1 <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR CD <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 3. <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) <br /> O m <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n n <br /> Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m z <br /> NORTH(N). m <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 /> 1 P <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. Z <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO o <br /> BUILDINGS,ROADS, LAKE, LOT LINES. <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. �1, <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS ,62 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. �O <br /> ' o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a <br /> NEEDED. <br /> Q <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: c t <br /> Q' <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. �vb\ <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INC' - - : - --- -- - - --- _ <br /> SETBACK AREA. This structure to be used as private residential °TER <br /> 5. garage/storage only. Not to be used for human <br /> habitation. n r- v o -U <br /> s. . dd CO <br /> am x CL m <br /> 7. <br /> fD C Nto 0 03 <br /> N > > <br /> O : <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my cj q . . m <br /> — � : m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of o. , C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m A <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- G> m <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 C <br /> providing in this application. I agree to permit county officials charged with administering coordinances or other <br /> unty ordinan <br /> authorized person to have access to the above described premises at any reasonable time for the purpose n inspection. <br /> m <br /> m <br /> : <br /> SIGN HERE m <br /> S- _6 Q d, <br /> ( n turowner or building contractor) " (date) <br /> ZONING ADMINISTRATOR <br /> J fn to cn w Fn to� <br /> Nch <br /> CA0En <br /> 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED u p' o u,p, 0 0 <br /> 0 0 0 0 0 0 <br /> 0000000 <br />