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V/t" <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> p �/ 1 r <br /> (�6/Ilh�� /V vI S/1 714,j / m o <br /> N <br /> C <br /> OWNER / p m <br /> PAVI a- j TELEPHONE b�Z /�j Ifff o <br /> HOME ADDRESS 737/ Gf,/r1G/ L,qC �in,i�% �/S G giAS �n Ss'y� v 0 <br /> y'o0 <br /> EMERGENCY/FIRE NUMBER (�0 `11 ROAD NAME <br /> jcbJ1^ S - o�/� <br /> LEGAL DESCRIPTION (see tax receipt) TqU R�6 W oyh4Pd 7't.Ad Ze, �S�l� yii`16 Cn <br /> TYPE OF PERMIT(S): DWELLING/BUILDING ElGARAGE/ACCESSORY STRUCTURE ❑ ADDITION X PRIVY ❑ 0 <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> 5. <br /> STRUCTURE/ADDITION USE: F/ti I„ i�m / h /OOA ')01> 0 J r�6 /o/x;y ° <br /> (Home/Cabin Commercial Busin ss; Bedroom; Deck; etc.) r� ° <br /> m <br /> BUILDING CONTRACTOR: Utt/r LunJ�, <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/]X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> � H <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o O <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). y ` 3 <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 <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 I <br /> BUILDINGS,ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. i <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS I Q <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. V <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT I' <br /> ISSUANCE. <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. <br /> vl " ;a -V fir 0� 0m <br /> 6. B am 'Pr x <br /> 9 : m CCWD <br /> y N O 3 <br /> 7. <br /> O . <br /> = r : <br /> c m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofCLm <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognizem M <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <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 (D <br /> authorized person to h aces a above described premises at any reasonable time for the purpose of inspection. n <br /> SIGN HERE ere" <br /> natur f owner or building o ctor) (date) <br /> ZONING ADMINISTRATOR ' v+ <br /> v+tn v+wwtn� <br /> N N(TNN (TN <br /> fT (T O fl1 (11 O O <br /> T WNSHIP PERMITS MAY BE EQUIRED <br />