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Bur(att County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o o gj <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> y O <br /> N 1`1 <br /> CD Vj <br /> C �r <br /> / ��T/> ..�. / / /+ TELEPHONE c 7 ,/ <br /> OWNER �" GL[ �M1i V 7 h-YJ�iL/ �,S L L C, ��O) J SV—212- 4 0 G+ <br /> f— m <br /> HOME ADDRESS (Y2,7— /(/ /�l i H 9 — LL1�7 l-y,��� Pk r — 6o <br /> EMERGES�CY/FIRE NUMBER f ROAD NAME ~ <br /> F <br /> LEGAL DESCRIPTION (see tax receipt) L Z 13 4- a,, A)L SE 2 7 �N _ /1/4 kl CD <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑\ADDITION ❑ PRIVY w <br /> TYPE OF PERMIT(S): c <br /> FILLING/GRADING - CAMPING UNIT ❑ SJ'BDIVISION .(,./J� <br /> l�f� .S12 r � s. <br /> STRUCTURE/ADDITION USE: v� O 1 P YI�S p 1 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;a .) �y U 1' ` <br /> BUILDING CONTRACTOR: <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. <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 m <br /> T a <br /> T O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m a <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> NORTH 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <br /> v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. ° <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 /> 5. 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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o e'i <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN q ° <br /> AJ <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> 0 <br /> CONDITIONS OF PERMIT: <br /> i <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. ( n <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY Q) <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER 9 <br /> SETBACK AREA. <br /> 5. <br /> 6. v (D " 0 53 <br /> CD <br /> — <br /> Cn. . : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my L7 c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of o <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <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 m <br /> IN: : : : <br /> providing in plication. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person t have access above descr' ed pr is at any reasonable time for the p rpose qf inspection. -n <br /> M <br /> m <br /> SIGN HERE JI-1-OL00 <br /> (signatu a of ow er or building contractor) (date) <br /> ZONING ADMINISTRATOR ' ' ` ' ' <br /> w t»to Fn w cn <br /> NL <br /> N Nf1i u7 <br /> (7i O V7 V7 O O <br /> TO SHIP PERMITS MAY BE REQUIRED <br /> 0666666 <br /> 0000000 <br />