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Burnett,County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning AdmirtiaCr for C v Ira z <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> OWNER Qt�t;r [ C�k. TELEPHONE CL <br /> Gtz 949 012-9 <br /> (� m <br /> HOME ADDRESS dal 3-1 1 x. nV1t+ SS'E3 1 0 <br /> r � <br /> 0 <br /> EMERGENCY/FIRE NUMBER ¢ ROAD NAME ICessle.— i 0 <br /> zi <br /> LEGAL DESCRIPTION(see tax receipt) NW I/H sw t/A stLT'Ac� Ig 14 <br /> W <br /> '1 0 <br /> ti <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGElACCESSORY STRUCTUREADDITION c <br /> n <br /> 5. <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION S� uC� <br /> J <br /> STRUCTURE/ADDITION USE: Z BR Co�o1V\ 2. <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) <br /> 'v <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T »_ <br /> 0 � d <br /> DIRECTIONS FOR PLOT PLAN DRAWING' (AERIAL OR TOP VIEW) T a <br /> ?� Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). C n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m v <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER. o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILD- I <br /> INGS, ROADS, LAKE, LOT LINES. Q,J <br /> 5. 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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. 1 ,� o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE '" o <br /> ISSUED. Cr W <br /> 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: V+ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> 1 <br /> ISSUANCE. O <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY O <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN 75 FEET OF THE OHWM OF LAKES, <br /> PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> A Q r�0 O <br /> �/J / 3C o m <br /> �� X01 14MOG 2 =. m d m <br /> 6. I� M,/ *-rL4,/1� v m ,'nr o = 3 <br /> 7. e -fro b z- V)Sd 0. 6� '- � <br /> Z : m m ; -1 <br /> O <br /> _co; : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G�c IS <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of CO C <br /> n <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o : m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- v <br /> sue a permit. 1 further accept all liability which may be a result of the Count t information I am m <br /> providing in this application. I agree to permit county officials ME <br /> o inancesor othermauthorized penton to have access to the above described premis p se of Inspection. m <br /> KSIGN HERE 0 l9gZ <br /> (signatur o wner buil ctor ate)ZONING ADMINISTRATOR AVANee- <br /> BURN <br /> w w fn fn fn <br /> � N N V7NN N <br /> ONING <br /> AWNSHIP PERMITS MAY BE REQU ED o 0 0 0 0 <br />