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CST( C <br /> ftrnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 < C, \ <br /> W O <br /> OWNER Ch"o ed �- • �OVCe E. C*rls a u TELEPHONE/��� 1) 691—OO Co(A m <br /> HOME ADDRESS `� , (Ly v e, PAvL, MlU 5-S{/ (a <br /> m <br /> p I o <br /> EMERGENCY/FIRE NUMBER t , y ROAD NAME �j-'r t 11 50 RDA <br /> SP- 15- L&1 Jy9v 5-0.1 3c?4, �. <br /> LEGAL DESCRIPTION(see tax receipt) 3ai <br /> 37/ R 1 S u.r U' o <br /> P <br /> ►- 7771 X070 Sr/Lc-.S0Ajj P/%ee- L(1T !� co <br /> co <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE 5 ADDITION ❑ PRIVY ❑ <br /> Cn <br /> TYPE OF PERMIT(S): cr <br /> C <br /> FILLING/GRADING ❑ CAMPING/UNIT ❑ SUBDIVISION ❑ m <br /> STRUCTURE/ADDITION USE: <br /> CAC / 8f1a'+- �'T�2 RG t 0 <br /> (Hom /Cabin; Commercial Business; Bedroom; Deck;etc.) rn <br /> w <br /> BUILDING CONTRACTOR: S L PAPS — OArC I�S g40S. COQ . 6-1-RucTuP-e (ow ker) Er <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'h X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> M y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o � <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 33 <br /> m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). N 3,_. <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m �O D <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. P <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. ly <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. 03 <br /> ° c� <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q <br /> NEEDED. 0 / <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c �1} <br /> CONDITIONS OF PERMIT: (1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 1 I <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 r(h� <br /> SETBACK AREA. 1 <br /> 5. 0 0 p <br /> 3 ra ek ;M0s. H � Q Z <br /> � , � �. " M <br /> � , <br /> m : : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Zi c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of ? a <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m <br /> m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- D <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. <br /> m : <br /> M : <br /> SIGN HERE <br /> (si nat re of owner or Ing contractor) date) n <br /> ZONING ADMINISTRATOR J/(^1t�q q' ` The <br /> �}L <br /> �i,� cn �noacnoo <br /> TOWNSHIP PER S MAY BE REQUIRED \� 0000000 <br />