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vl" yq C� <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v 0Z <br /> APPLICATION FOR LAND USE PERMITS 3 P <br /> itst <br /> N st <br /> N <br /> CD <br /> OWNER ©� /�,, TELEPHONE 6i,- `� 2/_ O� n <br /> �"✓�y O _ <br /> / m <br /> HOME ADDRESS9 W13 Ap< 5S369 <br /> / 9 <br /> EMERGENCY/FIRE NUMBER QD $S ROAD NAME -2 <br /> LEGAL DESCRIPTION(see tax receipt) y <br /> f � <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ y <br /> 0 <br /> TYPE OF PERMIT(S): � <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ c <br /> 7 <br /> [, OL( N <br /> STRUCTURE/ADDITION USE: t'C- Q � q9 , �1G /Wel5 � o' <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) y <br /> BUILDING CONTRACTOR: <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. In <br /> O n <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p m <br /> n a <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). CZ <br /> n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO CO) v <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 �U <br /> BUILDINGS,ROADS, LAKE, LOT LINES. 1 <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 /> 2. <br /> MUST BE SIGNED AND DATED BY THE OWNER. o I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P t <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ` O <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 (A <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER V <br /> SETBACK AREA. ru <br /> 5. <br /> 700RO -vv <br /> CCD • m . m o. m <br /> 6. v m Cy N o 3 <br /> 7. <br /> O <br /> =y: m <br /> I declare that this application (including any accompanying s Iced by me and to the best of my c p <br /> knowledge and belief it is true,correct and complete. I ackn a the detail and accuracy of d C <br /> all information contained in this application(including any mpan ying ) declare that I recognize m m . <br /> that this information I am providing will be relied upon by t ounty of Burnett Wiscon ' etermining whether to is- : p <br /> sue a permit. I her accept all liability hich may be a re of thL��//(� .`' B rrnett relyi on this information I am m' <br /> providing in is a ation. I agree to rmit county offioi s charged+hrirring my ordinances or other m <br /> authorized p rson t e ac s to the ve desc ibed pre an reasona__b�TTre```"'''�E��(tme fo a purpose of inspection. T <br /> i <br /> SIGN HERE ZO OUNTI' <br /> f afore df o r building contractor) (date) <br /> ZONING ADMINISTRATOR _ <br /> to <br /> v+v+v+w En v+ <br /> N NUI NN NUI <br /> UI UIOfTN00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br /> 0000000 <br />