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�n <br /> Burnett Q:)unty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office o Inistrator - 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> OWNER O ( TELEPHONE /a 71a— O <br /> �� - O'��S/`ti hardua/ Lu /46 <br /> HOME ADDRESS _ OS G[,tf /9j�Q�j/ I <br /> �YiaS mN s3z1/'7 wCD <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> o S <br /> o?.3- -/(o Lots t O, L.. /-C'.)m l/ /O 1 /35 BO J <br /> LEGAL DESCRIPTION(see tax receipt) GLJ - Lbc; _Cg��v/0 P/.13-/-W ccyr1✓6p(5'J \ -Al <br /> DWELLING/BUILDING ElGARAGE/ACCESSORY STRUCTURE ❑ ADDITION El PRIVY 1:1y o <br /> TYPE OF PERMIT(S): <br /> or <br /> E] ❑ SUBDIVISION a <br /> FILLING/GRADINGCAMPING'U/NIT Q ,(J /G� n , <br /> STRUCTURE/ADDITION USE: CSS V / � V - / % M*6 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) y Y' <br /> � (( 7� / d <br /> BUILDING CONTRACTOR: �� S�fZPn / 17�) ly As-S�Cy&7"-E <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O c O (kS <br /> S <br /> � Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m d \ n X \ <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE A <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m �3 3 <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. P <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. N J <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. o �. <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN '" o <br /> 0 r <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> - P►� a?95(S Q® Z TQ <br /> CONDITIONS OF PERMIT: c <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. o, <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ! J <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. d <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> x -0 mr.- tCo <br /> 6. 3 a N Q <br /> 'o mCu1No � <br /> 7. o G <br /> __ Cr <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Cr <br /> knowledge and belief it is true, correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of C. S <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m 2a <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to is. O <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 d <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other C m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. m <br /> m : <br /> CD : <br /> SIGN HERE <br /> (signs re of owner or buildin contractor) (date) <br /> ZONING ADMINISTRATORQ%L/ <br /> n������� <br /> N N01 NN 0111 <br /> 01 NOfT 0100 <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 0 0 0 o o <br />