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Bltrn9tt County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> CD APPLICATION FOR LAND USE PERMITS -AN Sr <br /> C91 <br /> y�(p �. Clane - 'tcLeu�avz( y <br /> OWNER q- POAlAIA- TELEPHONE <br /> HOME ADDRESS <br /> EMERGENCY/FIRE NUMBER �7 L7 ROAD NAME ; k/EZL.pwtel yF Q <br /> N <br /> LEGAL DESCRIPTION(see tax receipt) <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ,PRIVY ❑ <br /> TYPE OF PERMIT(S): n <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ UBDIVISIO <br /> N <br /> STRUCTURE/ADDITION USE: o <br /> (Home/Cabin; 42pmercial Business; droom; Deck; etc.) m <br /> BUILDING CONTRACTOR: °i <br /> v <br /> CDI <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> ,Tl N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> T <br /> T 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 rn o <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING3S)TO m 3 <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. \ ° <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. K <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. Q <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. 'E 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION ryl/1Y f3 - QE`WHEN B <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. ✓ Oct /j a <br /> CONDITIONS OF PERMIT: / CV <br /> Q <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF P <br /> ISSUANCE. co <br /> 3. NO GRADING OR SHYd <br /> 2. REMOVAL ORIORELAND NG ALTERATIONS A EOF TREES ANDl AILLOWEDTRICTED UNLESS SPECIFICALLY ALONG ©'v/% �'Y' r <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAIN NG WALLS, ETC.,ALLOWED WITHIN THE REEEQQU�IRRE�D WATER <br /> SETBACK A EA. , �"' / <br /> 0 3 n m Oc 5L�6. <br /> m ,� <br /> N N O <br /> Z CD O <br /> O Tl m <br /> �. - m <br /> — rn : [ A <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G> e <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail 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- <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 p <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to havccess to the above described premises at any reasonable time for the purpose of inspection. T <br /> m <br /> X/ 69 <br /> SIGN HERE <br /> (si lure o n contractor) (date <br /> -�� <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />