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�r2i-. eam� <br /> Burnett County 7410 Co. Rd.K,No. 102, Siren,WI 54872 Office of Zoning Administrator - o c <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> SUN <br /> / � vC <br /> OWNER ���iZ� �t TELEPHONE m <br /> jjjW <br /> HOME ADDRESS 1700 <br /> r <br /> EMERGENCY/FIRE NUMBER /b 7 ROAD NAME <br /> J <br /> LEGAL DESCRIPTION (see tax receipt) <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ <br /> TYPE OF PERMIT(S): ccc <br /> cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVisio 5. <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Busin�esss, Bedr m; Deck;etc.) <br /> BUILDING CONTRACTOR: l f �� h `f' ' ' <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR In 3 u <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. � <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) In <br /> ? KJ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m —IF <br /> c� <br /> NORTH(N). <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 k <br /> c <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. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN g �� <br /> NEEDED. II <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: U <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ) <br /> ISSUANCE. 1 Imo' <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY �U p�p <br /> PERMITTED. �V <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. m d + m <br /> 3oitoor� –�o � <br /> 6. <br /> o N �,c <br /> Z : nil x <br /> 7. m: <br /> M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best ofmy Gl c : 13 <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 any accompanying schedule)and I further declare that 1 recognize Wi m m <br /> G1 : O <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- d <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 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> n : <br /> SIGN HERE (date) <br /> (signature of ner or building contractor <br /> ll� <br /> ZONING ADMINISTRATOR ch X0 44 4A'A 4A� <br /> -JEL NCn NN P <br /> O 0 0 0 0 00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED N <br />