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ayNpl <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 0 Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> UT 0 <br /> OWNER Pa-0 J-eo n qA 1C n /� <br /> 1 �1rQh �, 'r ') IICrTELEPHONE /s-b8q-a�3s o <br /> �ry m <br /> HOMEADDRESS o� 3S$O �oknty Rd 1A� (�-ti^tln+s h� W-I 549go <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> a358o �.ourlf� RcQ• 1� , <br /> IQ-2q Vgg2- e foiq 2-3fi- 17- 19-0 03200 <br /> LEGAL DESCRIPTION (see tax receipt) •5 i9/T3s 17V AeRES 3,59 PCL FR PUJ lAI <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE 1:1 ADDITION 1:1 PRIVY ❑ �, Cl) <br /> TYPE OF PERMIT(S): � <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ �' <br /> STRUCTURE/ADDITION USE: U V-h ee, ^'/sJ' '`' `" C�i�_ 0 \ <br /> /� <br /> f ' e-(Home/Cabin; Commercial Business; Bedroo eck;etc.) N <br /> BUILDING CONTRACTOR: A- 1 �klnS . Rice Lake, <br /> m <br /> m <br /> m <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 =- Vv <br /> y OG <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> n o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 3 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <br /> n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m Q -%11 3 <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. 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 0 (> <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> o � / <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN T o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o v <br /> CONDITIONS OF PERMIT: � \ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT '(V� <br /> ISSUANCE. � I w <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY t OG <br /> PERMITTED. (� <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER lrJ <br /> SETBACK AREA. <br /> 6. �6ac avern� {o C� P�, !� �- 5�.a, � (dJ 464rnc�J��o <br /> 6. /fin o�[tSe 0► �hec�jcio3 m � _n <br /> _ <br /> n arD .� <br /> fU C y N <br /> 7. N N <br /> o O <br /> -" ;1 <br /> - t= AI declare that this application (including any accompanying schedule) has been examined by me and to the best of my G) c <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 /> CD <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 I am m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized personA have access to the abovjhdescribed premises at any reasonable time for the purpose of inspection. m <br /> T <br /> fD <br /> SIGN HERE (,. 9�� I�01 <br /> (signatur of o or building co tractor (date) x <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED o <br /> N dc- <br />