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Z L-:C rte <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 4 <br /> F o <br /> OWNER ��� TELEPHONE 6SI— —0 X95' <br /> f m <br /> HOME ADDRESS o,?06 OUIrle# [ Cr. N. f{, //✓g�; i, s S pRa O <br /> 9 <br /> m <br /> EMERGENCY/FIRE NUMBER 9 a l 7 ROAD NAME 7 rernS`&C/ �Q <br /> ( <br /> LEGAL DESCRIPTION(see tax receipt) m d <br /> G %�U/YiRi6 kf L/ /2BLt/ <br /> TYPE OF PERMIT(S): <br /> DWELLING/BUILDING ❑ GARAGEMCCESSORYSTRUCTUREA ADDITION ElPRIVY Elv� <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISIO ❑ 0;1 <br /> v <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) y <br /> m <br /> BUILDING CONTRACTOR: Se I F '- <br /> fu' <br /> 'o <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 77 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. InO <br /> � w <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p CD <br /> -n 0. k' <br /> -n , Z Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. a wo :b <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 vJ <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 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. c <br /> Cl o 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: c <br /> I <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 1 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY �Q <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER W ,177 <br /> SETBACK AREA. <br /> 5. <br /> m d v 'o <br /> 6. �' 3 a � .0 <br /> o m <br /> v : H m oF. 3 <br /> 7. Z . ,, , o . M � <br /> o A <br /> y. <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Zj C Q <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m <br /> CL <br /> all information contained in this application(including any accompanying schedule)and I further declare that I <br /> recognizem <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to is- m 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. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> p m <br /> SIGN HERE `p ' <br /> (signature of owner r building contractor) (date) +n <br /> ZONING ADMINISTRATOR i <br /> N N In N N(T f/i <br /> fly fly O Ili (T O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED o o 0 o o o o <br />