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67)z cf� <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 a Z <br /> APPLICATION FOR LAND USE PERMITS 3< ° <br /> N O <br /> N <br /> C <br /> N <br /> OWNER o TELEPHONE - o <br /> HOME ADDRESS �qqq '�L� rn�C2Ll LL ZI 1��Y St /7A <br /> r m <br /> 0 <br /> EMERGENCY/FIRE NUMBERROAD NAME U I <br /> LEGAL DESCRIPTION(see tax receipt) y <br /> ID <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE 14 ADDITION ❑ PRIVY El <br /> � 0 <br /> rn <br /> TYPE OF PERMIT(S): c r <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> n m' <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business; Bedroom;Deck; etc.) y <br /> BUILDING CONTRACTOR: /ni Is &1'20111n Y/<- ! h <br /> l(\\� <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8Y:X 11 SHEET OF PAPER. ANY INCOMPLETE OR � 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> y <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) 0n <br /> � <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m 9 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m :? <br /> NORTH(N). <br /> n <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. 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. <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. p <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR,ETC.,THE PLANS 0 N <br /> MUST BE SIGNED AND DATED BY THE OWNER. - b O <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. `� \ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P <br /> l <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. I � <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. AID PIuM'inq `c) b42, IIl 464T11-e-J &m' ;a -0 0 cl o -0 <br /> '3 L34 <br /> 6. m C y7. <br /> o <br /> = Cn: m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of d C C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize a m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to is ; p <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. 1 agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to theove described premises at any reasonable time for the purpose of inspection. T <br /> CD : <br /> CD <br /> 49 <br /> SIGN HERE �— S3 — 9 <br /> (signature of owner or building contractor) (date) <br /> �I. Y <br /> ZONING ADMINISTRATOR ' <br /> � . . . . <br /> 40 <br /> N N un u1 0 <br /> IT fn P V1 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />