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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v G) z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> OWNER I 0" SgeA4e TELEPHONE C7tS� 3�7-8� S9 0 <br /> HOME ADDRESS 1017 Pj Ae 1 erke ��, �I eQ E'SLC. LtIL 5q-Y3 o <br /> EMERGENCY/FIRE NUMBER (� /�'�Q� ROAD NAME <br /> ,2-37-19-Z2- -U 02ZaU GSM V' IBJ r �3v sN SL ^11446 <br /> LEGAL DESCRIPTION(see tax receipt) <br /> ;?,2-11 4tS/3s-1 g69/123 S;�a2/T37//21[90 16kl-12s3.i3oCn <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ® ADDITION ❑ PRIVY ❑ rn 0 <br /> TYPE OF PERMIT(S): n `r <br /> FILLING/GRADING ❑ CAMPING UNIT I,J SUBDIVISION ❑ a <br /> t f < <br /> STRUCTURE/ADDITION USE: NJ,MB L Lgwnmex-F uti�r ko-,tse 0 <br /> I'_e ^CH, (Home Cabin; Commercial Business; Bedroom; Deck;etc.) U) n <br /> BUILDING CONTRACTOR: Like s47-ucf00AErN <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> 3 � <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. /,I <br /> O H C w <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m J <br /> n a <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 d <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <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 v <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. NOd 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. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN O <br /> NEEDED. Cr <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. cQj <br /> CONDITIONS OF PERMIT: I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ppQ <br /> ISSUANCE. /V <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. (W, <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 /> ; v0r a 0 .0 <br /> 6. cm `a=;a <br /> 7. Z fe 's� <br /> o : <br /> E.y: : : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Cr 10 <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m f C <br /> all Information contained in this application(including any accompanying schedule)and I further declare that I recognize m 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 Iiabiiity which may be a result of the County of Burnett relying on this information I am 64 d <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other 00 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 /> m <br /> SIGN HERE 6A/-I 9 40 ' <br /> (signal of owner or buildin n actor) (date) <br /> ZONING ADMINISTRATOR <br /> 49 <br /> N N (n N N (T Cn <br /> VI U1 O VI ut O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />