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35 <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 O Z <br /> APPLICATION FOR LAND USE PERMITS <br /> r <br /> N 0 <br /> M <br /> OWNER (,((L- S�.CJ <br /> �/yy _D TELEPHONE (60) 7bb—I 1 a <br /> u�`•+.i'..1 I t� S-- „ <br /> HOMEADDRESS 38y 3 TI /( �T-} �f1�m�1C M C � v /v 0 <br /> EMERGENCY/FIRE NUMBER&1 -j3_1)a0o C ROADNAME01r],1010IdI.351 <br /> LEGAL DESCRIPTION(see tax receipt) L'C& a, GSM J 6 r 199 l60V 1000 I J <br /> o <br /> Q <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ o <br /> TYPE OF PERMIT(S): c � <br /> Q <br /> FILLING/GRADING El CAMPING UNIT ❑ SUBDIVISION ❑ o; <br /> STRUCTURE/ADDITION USE: QLurilae, o' <br /> —QHome/Cabin;Commercial Business;Bedroom; Deck;etc.) y <br /> BUILDING–C,�OtN,, � <br /> CONTRACTOR: _ L IT <br /> r IS$p;- <br /> A PLOT PLAN MUST BE PROVIDED O LEAST AN 8%X 11 SHEET..OF,PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. j ,, O 3 f <br /> .0 in tk <br /> DIRECTIONS FOR PLOT PLAN DRAWING, (AERIAL OR TOP VIEW) p m <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. OZ — <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m 1 ' <br /> NORTH(N).` C <br /> 3. SHOW DIMENSIONS 1N FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 1 0 <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. a <br /> 4. SHOW THE LOCATION OF THE)IVELL(VV�,SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO <br /> .BUILDINGS,ROADS,LAKE,"lbT�11�65. ?. � <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. M 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. G <br /> NOTE: BUILDING/StTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN Cr <br /> NEEDED. Cr <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P C> <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Q <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. l <br /> 5. <br /> r- <br /> 6. <br /> m o0 <br /> i �Om <br /> CL <br /> CD C,n e � <br /> 7. o ? H m ?m =j <br /> CA i ` <br /> I declare that this application (including any acco nying schedule) has been examined by me and to the best of my 65Cr <br /> p <br /> knowledge and belief it is true,coWrc <br /> . I acknowledge that I am responsible for the detail and accuracy ofall Information contained in this ang any accompanying schedule)and I further declare that 1 recognize M io mthat this Information I am providinPon by the County of Burnett Wisconsin in determining whether to is- E L3 E sue a permit. Ifurther acce t I ; m ,y be a result of the County of Burnett relying on this information I amproviding in this applicaIt unty officials charged with administering county ordinances or otherauthorized perscribed premises at any reasonable time for the purpose of inspection. In <br /> SIGN HERE a' d+ <br /> (sig re of owner building contractor) (date) <br /> di E i : <br /> ZONING ADMINISTRATOR CY <br /> d/fA di N(A(A <br /> N NN NNNtn <br /> ut NOUf NOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED 6A-'SA 0 0 0 0 0 0 <br /> �2 <br />