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07' GO,7te <br /> But'nett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS <br /> _ VJ <br /> OWNER N-/` C TELEPHONE <br /> HOME ADDRESS � ,�(`� A <br /> m <br /> EMERGENCY/FIRE NUMBER '01,21izYf ROAD NAME <br /> LEGAL DESCRIPTION(see tax reipt) L -U- (G 11 aId l aa3- %f-16 <br /> v7 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ <br /> TYPE OF PERMIT(S): n <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> Fn C -- <br /> STRUCTURE/ADDITION USE: S .0 to/ 0 <br /> (H/om abi /Commercial Business; Bedroom; Deck;eettc.)pO m <br /> BUILDING CONTRACTOR:,z22dCeC L//✓SC�iFi� / O�r 7 iu <br /> v <br /> m <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. p _ <br /> IZI ai <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <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 <br /> NORTH(N). y 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <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. So is <br /> O 9 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN q <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT O <br /> ISSUANCE. �- <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. I <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 v <br /> SETBACK AREA5. . 1 J1 <br /> 6. -r J� / �J/ $ 3 C mIx x <br /> m <br /> C( `` �J D nl CN N 7 <br /> CD <br /> 7. a fih �e eleva ��{ ��Id LM,nIn JahhC — 3ab' o N o, i z <br /> m <br /> I declare that this applica ' n (including any accompanying schedule) has been exam' ed by me ad to the best o y (j c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the det accuracy of a i? <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize (D 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- 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 <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 de ribed premises at any reasonable time for the purpose of inspection. m <br /> m : <br /> 40 <br /> m : <br /> SIGN HERE <br /> 10, (signature of owner Ilding< Vac (d e) <br /> ZONING ADMINISTRATOR /6M, 9 <br /> yrto v+to v+69 <br /> N NNNK) 0 <br /> V7 NOPNOO <br /> 00000 <br /> 0000000 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 <br />