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4 <br /> Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> CDm <br /> c <br /> OWNER J�N �lA� TELEPHONE �(0 — cf qlc� S <br /> HOME ADDRESS a ?"7 <br /> EMERGENCY/FIRE NUMBER c,2 ROAD NAME77b/vJtO5&j <br /> LEGAL DESCRIPTION(see tax receipt) 666 a5 7W/0 yD k15 da GOUT <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIW ❑ I[ CO <br /> TYPE OF PERMIT(S): �1 `oc <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <: <br /> STRUCTURE/ADDITION USE: <br /> WA' y 1<&JA14 Fr Gj loc— <br /> � <br /> � <br /> 1� ' . 1 (Hom /Cabin; Commercial Busines ; Bedroom; Deck; etct. m <br /> BUILDING CONTRACTOR: U/�I� OJ600 LAI-JQ-S"P642-5 <br /> v <br /> N <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p — <br /> in C\- <br /> DIRECTIONS <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) <br /> T <br /> CP <br /> �+ v 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 C) <br /> NORTH(N). fn O <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 ( Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. I O <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 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN _q ° f1 <br /> NEEDED. " V <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <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. ) <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. max GvidA 05;� 1IV4s <br /> vv0or, vvv <br /> s. S fa/rwa� mus{ bE rac�.f ►.�e (� + UItw C�rrldo. As w, t 4:7� �° M.0 c R-o = 3 <br /> yq � tp <br /> 7. o <br /> l� M <br /> _ur:: m <br /> I declare that this apple tion (including any accompanying schedule) hag been examined by me and to the best of my ( L7 c p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofc 0 c <br /> all information contained in this application(including an accompanyingschedule and I further declare that I reco <br /> cognize <br /> PP ( 9 Y ) g 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 <br /> providing In this application. I agree to permit county officials charged with administering county ordinances or other �; 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 /> SIGN HERE <br /> (s atu of owner or b ' g contractor) (date) <br /> ZONING ADMINISTRATOR ' <br /> drfnwfnw49 <br /> I A / ,^� N N (IiNN(liN <br /> /1/I Owl CJv J` OI fT O 01 (11 O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED �O�0 ^1 ) 3 0000000 <br />