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Bturne ,County.7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. Q ) <br /> OWNER SH Qy �f1KKE� }� Et- C�CS011'� TELEPHONE <br /> A 52D-34Lf D8?-E a o�� <br /> HOME ADDRESS �f 7(� I E , Lprex\ZCJ Lown- AMa� �1a . g53(o5 v <br /> M <br /> EMERGENCY/FIRE NUMBER 8� 3 ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) �o( y W//l vV� 1 I sa - U"/S I m <br /> n <br /> a <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION PRIVY ❑ U) ° <br /> TYPE OF PERMIT(S): Cr <br /> C <br /> FILLIN /GIN ❑ CAMPING UNIT ❑ SUBDIVISION ❑ L <br /> ,/� p / S <br /> STRUCTURE/ADDITION U !/ /t�f�pt tJ t G Aoz-A t8s c JC_f SfaE PLOT PLAM� 0 <br /> (Home/Cabin; Commercial Business; Bedr�; etc.) rn <br /> PC0JIuBUILDING CONTRACTOR: � C <br /> (/1 <br /> v <br /> CD ! , <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0C C 3 <br /> x <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <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). L9 oy�' <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 v l <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 9 <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. �. <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS t <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN W <br /> NEEDED. <br /> I <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 Q <br /> ISSUANCE. ) <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 /> SETBACK AREA. / ] <br /> 5.� 411 1 /UObvCO�t i^Iwj ¢ Pw��� qP hBixa .I A -13 0 r- v <br /> -s whl �h gncroul. on �5t LA 6e Svf6a�/ Mo � cNyo 3 <br /> 7:S1 / N O <br /> l�OtelQ TI.P Lau e..�0 /LST I-sGtr Ae1 P ' y Cn <br /> I declare that this appl ation (including any accompanying schedule) has been/examinedL6y me and to the best of my L7 c <br /> knowledge and belief it is true, cor nd complete. I acknowledge that I am responsible for the detail and accuracy of n C <br /> all information contained in this a� atirm ding any accompanying schedule)and I further declare that I recognize m <br /> rn <br /> that this information I am providi I�bg I i �rgQlj a County of Burnett Wisconsin in determining whether to is <br /> p <br /> sue a permit. 1 further accept all li h a ,.;fl}r�.�$ County of Burnett relying on this information I am d <br /> providing in this application. I e to perm it'corihtj/o a � r e with administering county ordinances or other m E <br /> authorized person to have acce _ the above described p er y reasonable time for the purpose of inspection. T <br /> m : <br /> JAA <br /> SIGN HERE I-,,- <br /> I <br /> 2001 <br /> (signatur fiodNlleeToo�byjlding contract ) (date) <br /> ZONING ADMINISTRATORUte, Y C <br /> Fntnwwcn <br /> N N M N N (T <br /> OI N00 Vt 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 6660 ' 0 <br /> 0000 0 <br />