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67( e6�0 <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 /> M <br /> c 0 o <br /> OWNER C>C <br /> TELEPHONE <br /> a <br /> HOME ADDRESS �t V' ( r f(/U `S's `D O <br /> o � <br /> EMERGENCY/FIRE NUMBER Z`JS�� /Z/� Q ROA AME <br /> LEGAL DESCRIPTION(see tax receipt) U. <br /> 1� m <br /> DWELLING/BUILDING ❑ GARA /ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ 1 C o <br /> TYPE OF PERMIT(S): p a <br /> FILLING/GRADING ❑ CAMPING U ❑ SUBDIVISION ❑ ^^��'� C)�)/ S <br /> STRUCTURE/ADDITION USE: /p(xY[� �0 <br /> (Ho e/Ca�Commercial Business; Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> W <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> m a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. �n 0v Z <br /> Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). (A o <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 <br /> BUILDINGS,ROADS,LAKE,LOT LINES. If\ `z <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. o <br /> 0 W <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN a <br /> NEEDED. n 6 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c I <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 71: <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 1 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> zv0r 0 0 .0 <br /> m <br /> 6. nNm �vn= 7g <br /> • m c o � 3 <br /> 7Z ' y <br /> . tel " <br /> o . <br /> = co <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Z)C 10 <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of Z m <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 County of Burnett Wisconsin in determining whether to is- m O <br /> sue a permit. 1 further accept all liability which may be a result of the County of Burnett relying on this information I am m E <br /> providing in this application. I agree to perms my ials charged with administering county ordinances or other m <br /> authorized person to ha eces the esc ' e remises at any reasonable time for the purpose of inspection. -n <br /> CDCD : <br /> SIGN HERE � • • <br /> (s g to egf owner or building co a or) (date) <br /> ZONING AD NIST TOR <br /> fn fn fn Fnww� <br /> 61/ /oyn <br /> N NNNNtn UI <br /> / Vt Vt O Ut Ut 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />