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67(- " <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 <br /> r <br /> N O <br /> N <br /> C <br /> (D <br /> OWNER ��,).. � // �.., � TELEPHONE <br /> v '6' <br /> HOME ADDRESS / t7 d S` C �� _ T S b v r G tll t �� <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> _ as-�B�� - I <br /> LEGAL DESCRIPTION (see tax receipt)) loci �� (\� �h Cn <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE L.,TJ ADDITION ❑ PRIVY ❑ I (n <br /> TYPE OF PERMIT(S): C Cr <br /> FILLING/GRADING ❑ AMPING UNIT ❑ SUBDIVISION ❑ \ <: <br /> n <br /> STRUCTURE/ADDITION USE: <br /> (Home/Ca ' ; Commercial iness; Bedro Deck;etc.) Cn <br /> BUILDING CONTRACTOR: <br /> CD <br /> CDI <br /> A PLOT PLAN M T BE PROVIDED 0 TLE TAN 8 X 11 SHE OF P ER. ANY INCO LETE OR T <br /> ILLEGIBLE PLOT 3. <br /> NS WILL BE RE RNED. 0 1 L <br /> A <br /> DIRECTIONS FOR PL PLAN DRAWI (AE L OR TO VIEW) 0 o ()�` <br /> n v Z <br /> 1. ALL REQUIRED DIM SIONS OR ISTANC TO BE S OWN OR DRAW ALE. m <br /> 2. SHOW THE LOCATIO ND SIZE F ALL EX TING B DINGS(E ALL NEW BUILDINGS(NB)AND IN <br /> C 0 <br /> NORTH(N). fn � <br /> 3. SHOW DIMENSIONS IN F T OF E FOLLOWIN A)BUILDING(S)TOby' <br /> LINES,(B)BU DING(S)T m 3 <br /> CENTERLINE OF ROAD,(C UIL NG S)ME EMENT TO THE ORDIH H WATER M WM) Z <br /> LAKE,STREAM OR RIVER A AS NT TO WETLAND AREAS. ° <br /> 4. SHOW THE LOCATION OF TH LL(W),SEPTIC TAN )ANDMfklD( ),ANDXR <br /> T ES TO <br /> BUILDINGS,ROADS,LAKE, LO NES. ) O <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNE D SH AREAS TO BE GRABED 1�,1 ni <br /> 6. IF SEPARATE PLANS ARE SUBMITT BY AN ARC c , NGINEER, ILDER,C T THE LAN Y �. <br /> MUST BE SIGNED AND DATED BY WNER. 1 o <br /> � � p I <br /> NOTE: BUILDING/STRUCTURE L( TI IRUST BE STAKED S A I RIFIC T BE DONE H N ° <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITI S LISTEDDBBE�W / o <br /> CONDITIONS OF PERMIT: ` /AjNT IN 6 DAYS OF P MT � � <br /> 1. DRIVEWAY MUST MEET DRIVE Y WI UUU111RRREEEMMMEEE / ^ <br /> ISSUANCE. I v) <br /> 2. REMOVAL OR CUTTING OF TREES N EG TATION ITRTCTED ALO S LINE.3. NO GRADING OR SHORELAND ALT IONS ARE ALL6 <br /> UNL S F ALL �JJ <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAI LLS, ETC L W HI IRED ATER <br /> SETBACK AREA. <br /> �0 n � DODO M1\�7�,111` INS o <. mC9m �cOa � <br /> � � 3 ar: <br /> — <br /> � <br /> 6. CD C s m 0 <br /> 7. m <br /> _ cn <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Q c <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of n a ';F0 <br /> all information contained in this application(including an accompanyingschedule)and I further declare that I reco nize <br /> PP C 9 Y 9 p <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 providing in this a lication. I agree to permit county officials charged with administering county ordinances or other <br /> CD <br /> authorized pers to ave access to the above described premises at any reasonable time for the purpose of inspection. -n <br /> m : <br /> ID : <br /> SIGN HERE <br /> ($I na ure of or building contractor) , (date) '. <br /> ZONING ADMINISTRATOR \ <br /> TOWNS P PERMITS MAY BE REQUIRED <br />