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"6tmp <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator v G) Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> 0 (1 1 <br /> N � �J <br /> UI <br /> OWNER TELEPHONE nIle <br /> HOME ADDRESS SSIOq <br /> EMERGENCY/FIRE NUMBER c22Ms ROAD NAME&14n 2p� <br /> LEGAL DESCRIPTION(see tax receipt) 0:2g I O D (30a m <br /> n <br /> c <br /> TYPE OF PERMIT(S): <br /> DWELLING/BUILDING 0 GARAGE/ACCESSORY STRUCTUREX, ADDITION ElPRIVY ❑ Cn c <br /> n <br /> FILLING/GRADING ❑ CAMPI/N�G UNIT SUBDIVISION <br /> SUBDIVISION ❑ S. <br /> STRUCTURE/ADDITION USEC3 l� 'v� <br /> �Y 1 (Homme'/CCabin; CC mmmercial Bus a s; edroo De ;etc.) Q` rn <br /> BUILD Nf G CON RACTT OR:`-�49i pG � Wn I ?X4-2-7A- �N t/3S Itoz-.5- 73 <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8Y:X 11 SHEET OF PAPER. ANY INCOMPLETE OR In 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> ,Z1 N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 o <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m M <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). C o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF - 43Z <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 <br /> BUILDINGS,ROADS,LAKE, LOT LINES. <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. WN <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. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN Cr <br /> " <br /> NEEDED. ) <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <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. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> zv0r a 0 .0 <br /> 6. �� m C <br /> 7. 0 <br /> o . <br /> = ys m <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my c C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m z <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 of Burnett Wisconsin in determining whether to is- D <br /> sue a permit. I further accept all liability which may be a re my of Burnett relying on this information I am m <br /> providing in this application. I agree to permit county o,' Is edv�riflt administering county ordinances or other m <br /> authorized pe to have access to the above described mises asonable time for the purpose of inspection. T <br /> p 6L m <br /> SIGN HERE S� a <br /> ( nature of er or Idin ,ctt'or) 6 (date) <br /> ZONING ADMINISTRATOR 1(11ri� <br /> �Ov+cn Fn En vi L" <br /> N C. N N V 7 N N N I T <br /> / 0 0 0 0 0 0 0 <br /> TOWNSHIP PERMITS MAY K RHIMUIRED 0 0 0 0 0 0 0 <br />