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, <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -U 0 z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> 6)! 63l 3.M7 yh y <br /> N <br /> C <br /> ,�/ 6SI-6-3I- ZgIXwY <br /> OWNER TELEPHONE f � p( � <br /> CD <br /> HOME ADDRESS �lL L( �� +-'k, N fir &1J f��/ N S fI °� <br /> o <br /> EMERGENCY/FIRE NUMBER ROAD NAME p/Jd VIZ rte) <br /> 4-a c5tn VY3 P9 8 al n^ <br /> LEGAL DESCRIPTION(see tax receipt koT �? 0 N Ib tU -al� J m <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE Ll ADDITION 1:1 PRIVY 1:1V) <br /> TYPE OF PERMIT(S): n <br /> Q <br /> FILLING/GRADING C MPING UNIT X SUBDIVISION ❑ n <br /> STRUCTURE/ADDITION USE: ° <br /> (Home/Cabin; Commercial Business; Bedroom; beck;etc.) 1 U) �J <br /> ..f <br /> BUILDING CONTRACTOR: LLE QktL �� r <br /> d rw <br /> u h e — 4o V, <br /> A PLOT PLAN MUST BE PROVIDED ON AT LE kST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR -e-1 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> j8id5. <br /> 71 w <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o kz <br /> T1. ALL REQUIRED DIMENSIONS OR DISTA CES TO BE SHOWN OR DRAWN TO SCALE. n2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m mNORTH(N). y3. SHOW DIMENSIONS IN FEET OF THE FO LOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <br /> CENTERLINE OF ROAD,(C)BUILDINGS)MEASUREMENT TO THE ORDINARY HIGH WATER (OHWM)OF os <br /> LAKE,STREAM OR RIVER AND MEASUR MENT TO WETLAND AREAS. o <br /> 4. SHOW THE LOCATION OF THE WELL(W],SEPTIC TANK(ST)AND DRAINFIELD(DF),AND A 1 <br /> BUILDINGS,ROADS,LAKE,LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS CANNED AND SHOW AREAS TO BE GRADED FILLED. ))// ( N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED B AN ARCHITECT, ENGINEER, BUILDER,CO_ CTOI*4PC.,THE L o <br /> MUST BE SIGNED AND DATED BY THE O NER. gall } v ? 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATIO�1 /o ONE o W <br /> NEEDED. A'A' A'T- <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. N�NG �,Y' !' o <br /> CONDITIONS OF PERMIT: 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT p, <br /> ISSUANCE. N 1 <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. p <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> c5. <br /> m m 0 ID <br /> 6. m 3 (D <br /> v m N o 3 <br /> 7. o m o 1 <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G) c <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of a 0 <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 re led 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 <br /> authorized person tqlba cess to the abqv de ribed premises at any reasonable time for the purpose of inspection. T <br /> CD <br /> SIGN HERE D L <br /> En <br /> (signature of own r uilding contractor) (date) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED 14 <br />