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Burnett Pounty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o° o <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> y O <br /> I ' <br /> OWNERS g0�Q�f d apy)q 'pl YClW % 4� "1 TELEPHONE —8 0 <br /> �l7 I✓• MIc(TA lPy p , TW 0 wt S3S'aq CRdGc0- <br /> HOMEADDRESS 004t C/fiMCjZT- CT. . I,tmuyAkF—E- W1 <3,512 O'UAI-0 r <br /> EMERGENCY/FIRE NUMBER p(7 4, ROAD NAME ,:�'TT�/vGC'\ D, <br /> P,I*rDFLUC 161 3 7R I — d <br /> LEGAL DESCRIPTION(see tax receipt)UN oZ/4 'f ��S 1/✓ `f 6 F 1—�ct �5 1 17`� C� CD <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ® ADDITION ❑ PRIVY CO ° <br /> TYPE OF PERMIT(S): Cr <br /> FILLING/GRADING ❑ CAMUNIT ❑ SUBDIVISION El <br /> N <br /> STRUCTURE/ADDITION USE: E PI NO i ivo t $ 'e K UNrr5 o <br /> (H me/Cabin; Commercial Business; B droom; Deck; <br /> /etc.) m <br /> BUILDING CONTRACTOR: SELF SHARE SFa��t rv� DAG <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR m � <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> 67W <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a <br /> ,n O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. v <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). CO) o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m B <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. ° <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 /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <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. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q1 ° <br /> NEEDED. g <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT O <br /> ISSUANCE. I <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 /> SETBACK AREA. <br /> 5. MA-y I — T7ruVA Iv, u , X -00 r- m �aou <br /> m 01 <br /> fp <br /> 6. e o 3 <br /> `�r`9 <br /> 7. J�i' _, tUUI o � A <br /> =m` m <br /> I declare that this application (including any accompanying schedule);h been examined by me and t the best of my ' E c <br /> knowledge and belief it is true, correct and complete. I acknowledge that Io y I m m <br /> and accuracy of '� � <br /> all information contained in this application(including any accompanying s 0 r 06 4ntl 1f==afe that I recognize ° � ' m <br /> that this information I am providing will be relied upon by the County of Burnett WisZ�t} N@ptermining whether to is- 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 <br /> providing in this application. I agree to permit county o ' m <br /> cials charged with administering county ordinances or other 1 <br /> authorized person to have ccs to the ab describe emises any r sonable time for the purpose of inspection. -n <br /> O —D - o � € <br /> ' : <br /> SIGN HERE <br /> (signatur of wneror I mgcontrac r) (date) <br /> ZONING ADMINISTRATOR <br /> N(�J 00 <br /> Vt O Vl O. <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> 1 <br />