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Burn t County 7410 Co. Rd. K, No. 102, S iren,WI 54872 Office of Zoning Administrator uwf N v G) Z <br /> APPLICATION FOR LAND USE PERMITSCD 0 <br /> W- 6S/-63 T 7036 <br /> OWNER O� �] t roe- TELEPHONE (D <br /> HOME ADDRESS 78' -7&ZS14 4v -S � .P CO3OOtJ! Ih/U '5—S016 <br /> ! r m <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> GoV, 4o I Sec Y, Z 3 ?Owns/,.jo cep /lort�l� <br /> LEGAL DESCRIPTION (see tax receipt) p /l <br /> r�� e 1? w Ps7' PrN o 3(0 '90/0 S 4 Z <br /> TYPE OF PERMIT(S): <br /> 40 <br /> DWELLING/BUILDING LIQ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION 1:1PRIVY Elc 0' <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITION USE: fknu( CA Ae j y' <br /> o <br /> (Home/Cabin, Comme(cial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: <br /> 2 <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/:X 11 SHEET OANY INCOMPLETE OR v <br /> F PAPER. m <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n 3 <br /> O - O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) <br /> O m <br /> T n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE n o � <br /> m m <br /> NORTH(N). C <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 ti <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. ' 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. 1 <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. �) <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS I 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. O o <br /> f <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. . d <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. d <br /> CONDITIONS OF PERMIT: zO P <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. I <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER j n <br /> SETBACK AREA. " I <br /> 5. f <br /> CL�S7"re-e4)S/'/ m m w 0 (D a : v <br /> �1'r /IV N C y y O 3 <br /> 7. 1"�// y <br /> n eu1eC �ul 7� curl fSA r QA 2 �Y Z : T" <br /> I declare t this application (including any accompa Ing schedule) s been exa ned by m Ind to the best of my US �^ A <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of a co A <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize N om <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- CD <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 o <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. `D <br /> CD ' <br /> SIGN HERE <br /> (signature of ow a 'orb n t ( te) <br /> ZONING ADMINISTRATOR <br /> TOW SHIP PERMITS MAY BE REQUIRED 8 <br /> 8 <br />