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Burnett C,-unty 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator - <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> OWNER =MRLEPHONE <br /> N <br /> HOME ADDRESS r-oc 1P �, k Ave ,. <br /> 1 r m <br /> 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME :PcOS ee G <br /> w <br /> LEGAL DESCRIPTION(see tax receipt) L® 4-- 8 ( k — , I I/aa p Ygl6o c <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ -0 <br /> TYPE OF PERMIT(S): I� c <br /> FILLING/GRADING ❑ CAMPING UNIT Dd SUBDIVISION ❑ a <br /> l�ops <br /> STRUCTURE/ADDITION USE: f? O <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) rn C (� <br /> BUILDING CONTRACTOR: <br /> .< <br /> -13m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O c <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m v a <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). 0't';ZZ) <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m , <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. N <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. So P <br /> O 9 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN a <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o d <br /> CONDITIONS OF PERMIT: \ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT Q <br /> ISSUANCE. ( 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. OC <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> X 'U 0r- 0Qy0 -0 <br /> M M. m j W m <br /> 6. v CDC ,nyo7. ' 3 <br /> o : ZN <br /> y: : ' W <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my cj c p <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of 0C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- w O <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 per ' county officials charged with administering county ordinances or other m <br /> authorized person to have access to the gKvit desgdS-eA premises at any reasonable ti'me.forahe purpose of inspection. T <br /> CD <br /> CD : <br /> SIGN HER /�/� — —0 <br /> slg azure o ner or buil g contractor) o u �06tte) r <br /> ZONING ADMINISTRATORL/L� C (JU / ? . . . ` e, <br /> i i(t t wwwfnww� <br /> TOWNSHIP PERMITS MAY BE REQUIRED 7©�r9�1{ 0 0 0 0 0 0 0 <br />