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Burpett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator v0 Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> N � <br /> OWNERLANd Soo ec e LLP TELEPHONE 3o7O W - 873 v �v <br /> MAILING ADDRESS <br /> PO 80x 1p SA � ee.0 fkP S4378 <br /> PROPERTY ADDRESS �%Af 6.t(//Y ROAD( I I Q� �V► t l t <br /> LEGAL DESCRIPTION(see tax receipt) 1-04- a CS11 �3 73 O V D /of /q e 60-61 91 . � <br /> DWELLING/BUILDING X GARAGE/ACCESSORY STRUCTURE ❑ ADDITION n <br /> TYPE OF PERMIT(S): a <br /> Cr <br /> FILLING/GRADING ❑ CAMPING UNIT 11 SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: 0 O x a Gra' Lh 8 ,t 01(' cove(ed CA 0 Q` <br /> (Hom pabinCommercialBusiness;Bedroom; D ck;etc.) vBUILDING CONTRACTOR: NSt Lbw OV <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR G <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O (D \ <br /> Z R ^) . <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 m <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 <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�j <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO Q� <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 i <br /> MUST BE SIGNED AND DATED BY THE OWNER. 11 a <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICAtE'TjONE WHEN <br /> NEEDED. <br /> (✓ w. I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. J/ 4610 o �I <br /> CONDITIONS OF PERMIT: [[( <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PE A' <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTNG OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINF�O <br /> 3 NO GR <br /> ZZ <br /> TDING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY 'y/�� C//VTy_ <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER ' /' I G� <br /> SETBACK ARE <br /> 5. �fd(� (Jl's�j f� -x.03 'd �S-�L/e. <br /> X0 g > 0 > 0 V <br /> 6. m m = g0 CL Mg :Em <br /> 3 am �cn.: CD <br /> a DcN o 3 <br /> 7. Z N M 0 <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my — m A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of d 0 c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize a 0 :m 0 : my <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 a0i <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> D <br /> authorized person to h e access to the above described premises at any reasonable time for the purpose of inspection. m m s <br /> M o : <br /> 8o3 <br /> SIGN HERE as <br /> (signal owner or building con ra tor) (date) aa <br /> ZONING ADMI ISTRATOR <br /> fA di fA di -+ N <br /> f'� N (TNNOO <br /> �J(TO (TNOO <br /> 7TWNSHIP PERMITS MAY BE REQUIRED <br />