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&44C@yA-P <br /> Burne-ft-County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> y O <br /> N <br /> CD <br /> , 1_ C <br /> OWNER �rl,t AM ,T ow-,^ CAUsTVy3EJ TELEPHONE `I CJS 9.337 9 n <br /> 990 S 5 S 7i,1 q <br /> HOMEADDRESS VIyuauT61 "%, <br /> 5'S447. 0 <br /> r m <br /> 0 <br /> EMERGENCY/FIRE NUMBER %gOAj E VLrU4% . �� � �AD NAME <br /> LEGAL DESCRIPTION(see tax receipt) m <br /> m <br /> d <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION PRIVY ❑ r rn o <br /> � <br /> TYPE OF PERMIT(S): cc <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ q <br /> T H <br /> STRUCTURE/ADDITION USE: ah=t 8 n 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: SpMQ Ai 1.u%w <br /> v <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. <br /> XI N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> m Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m �? <br /> NORTH(N). y o <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. P <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 /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. \ (\ , <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS JOV <br /> MUST BE SIGNED AND DATED BY THE OWNER. 1 o <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z (� <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ' O <br /> ISSUANCE. pN� <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 5EQUIRp WATER <br /> SETBACK AREA. J ,` �(`� <br /> 5. $.�©/ ( N� ('1;7 � PSG vim <br /> M M. d , <br /> 6. 8.� 3 C CD EL — ;U <br /> 7. <br /> O . <br /> rn : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my i ID <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofo g <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 m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to the above described premises at any reasclropkq time for the purpose of inspection. m <br /> m : <br /> m : <br /> SIGN HERE Od <br /> (signature of er tractor) 7 <br /> ZONING ADMINISTRATOR ` M4je <br /> �N <br /> to N ro fJul w yr er <br /> N N fly N <br /> T01 <br /> SHIP PERMITS MAY BE REQU 0 0 0 0 0 0 0 <br /> ,�`(0000000 <br /> ZCNJ (C <br />