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L7nt h/w <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> � � ` n o <br /> OWNER M ( L H(�IC[ S TELEPHONE 1 t _32 _ c4 <br /> HOME ADDRESS Z O 30 L vaj-v E w o o� 7 r R 14rvT S3U (2C-dV0 " <br /> fff o <br /> EMERGENCY/FIRE NUMBER ZO 9 3p ROAD NAME LF}1<EIAJ pQ O O/' 1 <br /> LEGAL DESCRIPTION (see tax receipt) am:I -► o y b3/'fb5 W�b l�z.� 5 z l h-�1�Qt 6 � <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIW ❑ to � <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> �\ N <br /> STRUCTURE/ADDITION USE: i-1�Q\T1 O✓tel O �y 1q 2 WrC�I� <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) rn <br /> BUILDING CONTRACTOR: 5CL t� <br /> t� <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m - <br /> 0 in <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m O p <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). y c <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 112) Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. P <br /> 4. SHOW THE LOCATION OF THE WELL(VII),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO <br /> BUILDINGS,ROADS,LAKE, LOT LINES. V <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 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. Fo <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN Cr <br /> NEEDED. ) <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. �v <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 0 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY I <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. I, / /� ,I / / <br /> NO E' CeeG� ��p/� `fir N�- YaYr+e,7eq ��1P la <br /> � v M) r � m <br /> 6. N / oZ�0V7, �J .Sc°l dQCr" m � 3 CL 0 L � <br /> —Z COD <br /> 7. P <br /> y ; m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of o C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- oO 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 44 m <br /> providing in this application. I agree to permit county officials arged with administering county ordinances or other m <br /> authorized person to 0dV`e*cesstolA 4pve descr' d premi sat any reasonable time for the purpose of inspection. n <br /> m : <br /> m : <br /> SIGN HERE �—Z Z —� <br /> (signature o 0 or bI (date) <br /> ZONING ADMINISTRATOR <br /> to tnw 40 <br /> N Nfn O NUn to <br /> (P (n IT fT O O <br /> WNSHIP PERMITS MAY BE REQUIRED <br />