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-o <br /> Burgett Co3inty 7410 Co.Rd. K,No. 102,Siren,WI 54872 Office of Zoning Administrator v G) Z <br /> APPLICATION FOR LAND USE PERMITS <br /> N <br /> OWNER -f-� �l- TELEPHONE O y' - y�-7 f7 K pi7 <br /> ! m_ <br /> MAILING ADDRESS 24 m <br /> r CD <br /> 0 <br /> PROPERTY ADDRESS 7Z-) <br /> LEGAL DESCRIPTION(see tax receipt)P X L5W Ntj C;�q /0-16 <br /> C � <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION / , rn <br /> TYPE OF PERMIT(S): n <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ �. <br /> STRUCTURE/ADDITION USE: <br /> // (H <br /> Hoome/Cabin, Commercial Business; edroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: Se 4 I <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> .0 co <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> 'il o Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. mjp <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(148)AND INDICATE <br /> NORTH(N). y o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(8)BUILDING(S)TO m p¢ ` 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <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 J <br /> BUILDINGS,ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRA R ILLED. c <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDE R nPNS <br /> MUST BE SIGNED AND DATED BY THE OWNER. (� L NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VE ATION MAYBE DO J� <br /> NEEDED. AUG —� 9 2004 Z �► <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Rp <br /> URIV <br /> CONDITIONS OF PERMIT: E7T COUIV. <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ZONING <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 <br /> SETBACK AREA. (� , ✓ <br /> 5.171 '( r/( Mm w a rail <br /> 6. (/ 3 am c� c <br /> a m C w y <br /> 7. cot, 00 <br /> a <br /> Z r Q '; : M <br /> = rn: : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my O <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofCL ro �_ : C <br /> all information contained in this application(including an accompanyingschedule and I further declare that I recognize r� ` m $ : G <br /> PP ( 9 Y ) 9 UE m : E <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- ; <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information lam ? >n ill: <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. rn i <br /> o : <br /> ID/ r Grip m <br /> SIGN HERE <br /> (signatur ne building co ac ) (date) a i <br /> ZONING ADMINISTRATOR <br /> QQ 2 C GN0N O <br /> 0 I � I TOWNSHIP PERMITS MAY BE REQUIRED I' J CJ o'o <br /> L� <br /> enAN THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />