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O/- Gc'n' <br /> Burr,stt County 7410 Co. Rd. K, No. 102,Siren,W154872 Office of Zoning Administrator CD o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> N O <br /> OWNER ^' LEP`H'ONNE <br /> HOME ADDRESS <br /> 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> i <br /> cn <br /> LEGAL DESCRIPTION(see tax receipt) SE a© <br /> C — to — — ) L� <br /> GGGG�LL------ o 1D <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ElADDITION ❑ PRIVY ❑ <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING CAMPING UNIT 11 SUBDIVISION ❑ n <br /> 5. <br /> 0, <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: J r C� �I CC( M Q p fit <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m 3 ( ( <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> DIRECTIONS FOR PLOT PLAN DR WING: (AERIAL OR TOP VIEW) c <br /> O <br /> T o O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> NORTH(N). 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <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. �j I ° <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO y!1 <br /> BUILDINGS,ROADS,LAKE,LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. I IV <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. °d v �tJ <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN q <br /> NEEDED. <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 f <br /> ISSUANCE. (� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Q <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. tOw r �i 0m <br /> 6. y m o �� 1 <br /> Z E m Z <br /> : A <br /> 7. _ <br /> =y : : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G� C <br /> knowledge and belief It is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of a <br /> all information contained in this application(including any accompanying schedule)and 1 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- l7 <br /> sue a permit. I further accept all liability which may be a result of the County of Burnettr a i @ f ID <br /> m <br /> providing in this application. I agree to permit county officials charged with adminis n n c r <br /> authorized person to have access to the above described premises at any reasonable i r i <br /> q/ m : <br /> w : <br /> SIGN HERE I r <br /> (sign re (crate) <br /> of owner or b contractor) l <br /> ZONING ADMINISTRATOR 91 lRNF-rTLINTY <br /> WNW:, !M SAP P o <br /> O 0 0 0 0 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED C> 000000 <br />