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ab Gc-�r� <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 0Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> _ r <br /> CD <br /> c <br /> ] � <br /> OWNER I LC.Lt I-o(a Yl TELEPHONE /�_ C16�_ ONt <br /> aim cc?I lei, <br /> HOME ADDRESS ��1 � � J m <br /> 4) 0 g <br /> EMERGENCY/FIRE NUMBER a 6 94— ROAD NAME <br /> o f �l e.sM V S4 e r 36 <br /> LEGAL DESCRIPTION(see tax receipt) -PeA,V C L # D D l/� 70(7 ur <br /> P <br /> DWELLING/BUILDING ElGARAGE/ACCESSORY STRUCTURE El ADDITION PRIVY ❑ u! 00 T <br /> TYPE OF PERMIT(S): <br /> cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBD/IIV1�[SI/O.N ❑') r�m6]^1 ^], /^ o; <br /> STRUCTURE/ADDITION USE: / / IC� P�1G rb1 L <br /> /1 (Home/Cabin;Comm rcial Business; Bedroom; Deck;etc.) Ix�/ ,( y n ` <br /> 'l <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCO PLETE R m <br /> El <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. Jee p� �/ In <br /> 0 N <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) /)a'-19 Iq jq 0 ii <br /> x Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). y 3 <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 <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 C9 <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. so SJ <br /> v 9 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHENa o ) <br /> NEEDED. 0 O <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c V I <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 1 <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. �J <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 /> am C F. <br /> 7. Z HCh� <br /> o : <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofCL <br /> m e <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m <br /> that this Information I am providing will be relied upon by the County of Burnett 1,1 IIs ami 'ng whether to is- O <br /> sue a permit. I further accept all liability which may be a result of themed $f j�yhl i 'information I am y <br /> providing in this application. I agree to permit county officials cha & h��f� ri Ir finances or other o E <br /> authorized person to have access to the above described premise enable(ime for the p se of inspection. m i E <br /> pn�y m : <br /> SIGN HERE ^`' UG 17 <br /> (sign re owner or b�traclor�S�,ZONING ADMINISTRATOR URyETT COUNTY <br /> IN N((A N V7 <br /> N V7 O V• O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0000 0 0 0 0 <br />