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Burne;-County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 0 G) <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> N <br /> OWNER li L {� I-�/� �°'�sD�/ TELEPHONE U�'�� C� o 00 <br /> m <br /> r v �) <br /> HOME ADDRESS , C ��� 4f ��// y���0 3U 0 <br /> I r � <br /> EMERGENCY/FIRE NUMBER ROAD NAME \y" A� � I o <br /> LLOW L4I- <br /> LEGAL DESCRIPTION(see tax receipt) T w P r `IU �� L O T S/WI (/ 1�l D ') m <br /> 0 <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o PRIVY Vl � <br /> TYPE OF PERMIT(S): Cr 51-117 <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) tn01 _ <br /> BUILDING CONTRACTOR: A17z b L L IZ /�/.°/!//��ll G�L6;— <br /> v <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 S! <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 �l <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 <br /> TCL <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m O <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C �?F n <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 3 <br /> v <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. 1 <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. IV <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. c <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q <br /> NEEDED. [ h <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c Q V <br /> CONDITIONS OF PERMIT: n <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 7' <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 �l <br /> PERMITTED. lJ <br /> 4, NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. zv0ro�vv <br /> 6. m3amsic' Q .'u <br /> N C <br /> Z COD <br /> 7. <br /> —rn m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofo it <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m 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. 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 with administering county ordinances or other m <br /> authorized person to ave access to the Otve desgribed premises at any reasonable time for the purpose of inspection. -n <br /> C �J m <br /> SIGN HERE , — x r �� <br /> (sig ature of owner building contractor) (date) <br /> ZONING ADMINISTRATOR . . . . . . d+ <br /> �fA""4ft 61�� <br /> N C31 1%) ro 01 CA <br /> 01 Vn U1 OO <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 <br />