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Burnett founty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v cl z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> y O <br /> N <br /> OWNER I'Ylu h l e CUIMLE <br /> /� TELEPHONE 3 q-933o C <br /> HOME ADDRESS Lr�I � '/v 1 cl CI S+er LI LS 5 /b 7 3 v 9 <br /> EMERGENCY/FIRE NUMBER 4 s J ROAD NAME \ l 1 1 'Y <br /> PSILEGAL DESCRIPTION(see tax receipt) <br /> 7 o t m 7x� <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORYSTRUCTURE ❑ ADDITION PRIVY ❑ y o 6,Y <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION CL <br /> ❑ <br /> /, l {��n 1 Ln. <br /> STRUCTURE/ADDITION USE: i � GYJ (fUB/� 144- � S i[�d o_ <br /> % (Home/Cabin;Commercial Busi ss; Bedroom; Deck;etc.) S/�Q�p co �> <br /> BUILDING CONTRACTOR: <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 � p <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. OT n W <br /> X N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p m <br /> " a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. z <br /> -n m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). C 0 <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 Z <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. D <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHENq o <br /> NEEDED. o <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z <br /> CONDITIONS OF PERMIT: a <br /> 11 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ( O <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3 NO GR <br /> TDIN OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THS R IRED WATER <br /> SETBACK/�AREA. /� ' <br /> 5. Np 4Jdt47&r J )luviar Am, 'tcs 6,e- c/plc- <br /> 6. �'� Ld F-'- ` n 3 0'r- <br /> MDT n a m <br /> `_.! N. V a N 0 C_ <br /> AUG �� <br /> �. z € Ngo ° '� =j <br /> P ' <br /> E Ca E E m <br /> I declare that this application (including any accompanying schedule) has been exa ��y�,,,�,,�pYy�� and to the best y c p <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am responsible N eld ccu of m ° C <br /> ��f�' : a E <br /> all information contained in this application(including any accompanying schedule)and I fuii 1 int cognize C m i M <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in d tetlig whether to is- p <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 abovqydescribed premises at any reasonable time for the purpose of inspection. <br /> m <br /> SIGN HERE d' <br /> (�Inat a of owner o Ing pritractor Alto, i <br /> ZONING ADMINISTRAT R <br /> O V1 (] O (T (!1 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 <br />