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/11 <br /> 0- &V- <br /> Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zonirt'g Ad mtnls rator - 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> N O <br /> /� Q�.' /��� � � /gyp N <br /> OWNER t'(/'TRl�5 TH9-'FJA 6/j—/V N�Jt TELEPHONE 65/ 653 q 1-7 2 0 <br /> d <br /> p <br /> MAILING ADDRESS 720 g G 2 R t D G E 14U60, AANI 5S-0 3 g O <br /> r � <br /> PROPERTYADDRESS Z 7 S 7q L i N Co L 4 AVE, 8 Sme I W I o <br /> � 1 <br /> LEGAL DESCRIPTION(see tax receipt) L. oT2 OF Lo-r 10 , 2"'�grDA1T101I '111 JEFFft1F� BS'fA' � tl` � <br /> r, <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE Fr ADDITION ❑ o <br /> TYPE OF PERMIT(S): v ' <br /> FILLING/GRADING ❑ CAMPING UNIT SUBDIVISION n <br /> STRUCTURE/ADDITION USE: GN U �� R <br /> (Home/Cabin;Commercial Bus' ess; Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: 421 C,VIARr!' GpQ I< <br /> ;v <br /> v <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 /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n 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). Cn <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 Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 1 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. , Q <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED O FILLED. n <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONT ETC.,THE PLANS (� w <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> W g <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFIC ION MA Y ijt 0 <br /> NEEDED. <br /> I � <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. #o 19 p <br /> CONDITIONS OF PERMIT: BVA a0 , 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT �0 J <br /> ISSUANCE. � 'v//V�UN� <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. <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> ETBACK AREA. <br /> 5. C 1�1C�i� � �> l/Sr <br /> /�ly� A nrDODO 'D <br /> s. � (� O��/n// / /1 /'l0 j4f17 M use 7 3 C 'D � a m <br /> nm Fa = ,n <br /> This structure to be used as private residential -5 N 0 y E5. 9 <br /> 7. garage/storage only. Not to be used for human o a „0 <br /> habitation. rn <br /> I declare that this application (including any aL__...�_..,...a , .. «.. . „y Ma 411U w Lhe best of my [ �j '. . ; A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofd C . C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize `` CL m � o m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- W (D C <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 oOi <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to <br /> the above described premises at any reasonable time for the purpose of Inspection. m o <br /> SIGN HERE n <br /> (signatu of owner or building c ntractor) (date) : <br /> ZONING ADMINISTRATOR <br /> w1 EA EA f/+fR�N <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> d5��0 cnocncnoo <br />