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Burnett Coun 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> p �p M , ^ yT 0 <br /> N " <br /> OWNER 90062r 9, PVA PA4-A VC, 'PK0di\J TELEPHONE X7/15 9-3 2-744 <br /> HOME ADDRESS 28(0:5 W FiLG IgKoI�1 pe. \4/, cAtA uAj kei W I g 1 !os O� <br /> CD <br /> EMERGENCY/FIRE NUMBER 27731 ROAD NAME MosE2 kOA-D <br /> WIG-15v 2 2 9 5741-7(o W <br /> 2-x}0-15-2q-0 021 <br /> LEGAL DESCRIPTION (see tax receipt) (p CSIH V 8 Q 3 (I�( 60V LOTS 2E 3 E NI12 NEI I4� m <br /> 00 <br /> DWELLING/BUILDING Kj GARAGE/ACCESSORY STRUCTURE ElADDITION ❑ PRIVY 11I y o <br /> TYPE OF PERMIT(S): w <br /> FILLING/GRADING ❑ CAMPING UNIT 1:1SUBDIVISION ❑ o. <br /> . <br /> T <br /> STRUCTURE/ADDITION USE: <br /> NaME y <br /> r' (Home/Cabin; ommercial Busin ; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: a(LL'roP P(AI LV6l?,S &ARy McTnfO,SH f� <br /> _ -� <br /> m <br /> CD <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 C <br /> i0 N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m v <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). y o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 9 <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. P <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. m c 1 <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN CrNEEDED. <br /> 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: O <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. c` <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. r JU <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. <br /> A m <br /> 6. m,-< CL Q%Q ."0 <br /> m <br /> , / - i� v <br /> J� Cin N > > <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my L7 c 10 <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize �^ m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m t7 <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 /> providing in this application. I agree to permit county officials charged with administering county ordinances or other Co <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> SIGN HERE <br /> m <br /> (signature of owner or building contractor) (date) <br /> 469 40 69 <br /> ZONING ADMIN STRATOR 11 GNII 0 40 <br /> C)N NM N 0 0 <br /> Vt U1 ON 000 <br /> O 0 0 0 0 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />