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Wb,,,_b <br /> Buml ett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> J,n <br /> Name / C <br /> OWNER ,4AI 1A.n �L� 1 MACH 116.! TELEPHONE yS� 5�� - Iv / o M <br /> V m <br /> HOMEADDRESS 1900 1-00 '1 '51 A--IJA P(-Je__ 1�6 eDT. LcUi5 PA-rzI4 AtJ- 0 <br /> / �/ J 0 N <br /> EMERGENCY/FIRE NUMBER l9'1� i C1kP��,J ROAD NAME L i L Lam; <br /> -7y.,qc c e t27- <br /> LEGAL <br /> `ZLEGAL DESCRIPTION(see tax receipt) -EF- Pt-%-T-AC+{C '# 6),C) <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE, ADDITION ❑ PRIVY ❑ 1 <br /> TYPE OF PERMIT(S): Q o <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ _ <br /> STRUCTURE/ADDITION USE: `��- � 15T-0r2,A& S <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) U) <br /> BUILDING CONTRACTOR: E I t1> <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR m� <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> n n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m �3 <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 <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. (} <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 'V <br /> MUST BE SIGNED AND DATED BY THE OWNER. o Q <br /> f <br /> _ <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. d <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. <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. (1YjJ <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> This structure to be used as private residential A v 0 r- a o D o v <br /> 6. garage/storage only. Not to be used for human 0 < 3 a 0 0 a <br /> .Q N C N �' O <br /> habitation. Z o CD <br /> O <br /> �. : m <br /> _ � O <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m <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- <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, s or other <br /> authorized person to have access to the above described premises at any; s 1 b r 4 l"f' pection. m m <br /> ID <br /> �1 m <br /> SIGN HERE <br /> (signature of owner or building contractor) Q)I J e a 01 (dat <br /> ZONING ADMINISTRATOR /(Yl f1371;X31 <br /> LJ c �U) <br /> BURNETT COUNTY <br /> TOWNSHIP PERMITS MAY BE REQUIREDZONING C) <br />