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9120-p <br /> ,nty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator CD o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> o <br /> CL <br /> 4ER YA I-:s L JORPAN TELEPHONE 95�,-4��-}-�83 � o •) <br /> rp� 0 <br /> HOMEADDRESS 20.2 3(o COTT-AGEWoOD FAD NEPHjkliem MN ss33� <br /> r <br /> ' 1 pp 0 <br /> EMERGENCY/FIRE NUMBER qL'�3 rj ROAD NAME B E KT R A M LSD. <br /> tot C° s8µ/4_1y 58114 3 0 $00 <br /> LEGAL DESCRIPTION(see tax receipt) 3&'-15—oq-o GOV LAT Q .0 <br /> 5vg1T38R <br /> 1 <br /> cn <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION PRIVY ❑ / c. <br /> TYPE OF PERMIT(S): n <br /> FILLING/GRADING 11 CAMPING UNIT 1:1SUBDIVISION ❑ j�-To-t ,I AW1, lU��y+Oldf��'3y �. <br /> STRUCTURE/ADDITION USE: CA0;►3 AyDtTt 00 " ^^ � tI <br /> LOSS I AAS /yam/ <br /> (Home/ abin; Commercial usiness; Bedro ; D k, etc.) <br /> J � <br /> BUILDING CONTRACTOR: ELF <br /> m <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PA ER. AN �CCOeMPVTE O�.�� O 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. J 5I� c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) �5 n n <br /> T <br /> T 0 Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCAL m >' <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m o <br /> NORTH(N). 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. 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. I <br /> v � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN ° <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: C>� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. V\ OQ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELIN <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY ID <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQ I D WAT <br /> SETBACK AREA. ,I <br /> 5. Us 1 dm0co Em <br /> 6 001 3 'amO ° <br /> 6. BORN y � aN � 3 <br /> 7. �!J �- Z CpUN z <br /> ° ' m <br /> I declare that this application (i cluding a ccompanying s edule) has een examined by me an to the st of my G7 c' c <br /> knowledge and belief it is true, orrect and complete. I acknowledge that I am responsible for the ail and accuracy of o <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize : m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m <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 otherCD <br /> authorized person to have access to the abpve described premises at any reasonable time for the purpose of inspection. m <br /> m : <br /> CD <br /> F» <br /> SIGN HERE I �0' <br /> (signature owner or bu ding c tractor) (date) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />