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UhCo W <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator -0 0 Z <br /> APPLICATION FOR <br /> tND USE PERMITS 3 ` <br /> OWNER ��T d L�N�E7TE �� �� TELEPHONE 763 -3x3-1571 o �' <br /> m <br /> HOME ADDRESS �95 AW,-JUL Mh& AD j + JAE"0140 Tvwn/S]{lP O <br /> r m <br /> 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> I Prt L6. csrn �✓.s P - \I y3 <br /> LEGAL DESCRIPTION(see tax receipt) 0 Srn P� �7D G--L3 ar/_�/� I <br /> CD I <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION PRIVY ❑ Y' 7 1�Cn o <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ o. <br /> STRUCTURE/ADDITION USE: (26/3l rnl AD D r-r'i o n) L^O <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) cn:� <br /> m <br /> BUILDING CONTRACTOR: w <br /> m <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> Tl N O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O.c n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m� <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). y <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 o <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. <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. ( F <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN <br /> NEEDED. T <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 <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 /> Gy !/v /U�'/ C'9 1� �/7F/8� d�- O <br /> CD � 0 0 CD C a p m <br /> 6. / m � 3 'o. m 0' m ;0 N C: m O = 3 <br /> N O O 0 <br /> 7. Z . <br /> O : T� <br /> U, m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my X) G) D <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of o <br /> all information contained in this application(including an accompanyingschedule and I further declare that I recognize ` <br /> PP ( 9 Y ) Dom : p <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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other W <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m m <br /> m <br /> m <br /> SIGN HERE VI/, <br /> (signatu of owrribuildigifcr) (date) <br /> ZONING ADMINISTRATOR VATZI <br /> O '9� <br /> TOW SHIP PERMITS MAYBE REQUIRED <br />