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6w("" <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3r <br /> - <br /> F O <br /> `l � �Tf7 f <br /> OWNER TELEPHONE 7/5'— /Z—a 10 p <br /> 0 <br /> HOME ADDRESS 6667 46-v rr4 g, U 77-mevu r W CDr <br /> o <br /> EMERGENCY/FIRE NUMBER QV+ I ROAD NAME �i9.Q�C sr <br /> LEGAL DESCRIPTION(see tax receipt) J�j 4'�+'s LgaC6f SNoA i .Di Q �J m <br /> Y6cca,� L.slcar Lor <br /> C' <br /> s/, r3 3 Ba/C 9 4 - <br /> DWELLING/BUILDING El GARAGE/ACCESSORY STRUCTURE ® ADDITION ❑ PRIVY ❑ �] 0 <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <.� <br /> STRUCTURE/ADDITION USE: I(;AM A615 t4 062K OA�) U S <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) U <br /> BUILDING CONTRACTOR: <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR In <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n O <br /> T v z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C o <br /> NORTH(N). N <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 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. <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. Q <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 �� `{b� <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 S <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. P O <br /> CONDITION$OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT G <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. C-No <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER LL <br /> SETBACK AREA. NJ" J' <br /> 5. <br /> p h .l,J 7V+'-T-' r t-�C�-O�-✓ .. 3 n m <br /> _ L J /p m n m �c Q 70 <br /> 15 Q Ti✓� - . �D ZYY o NCOD <br /> 7. C t��/»/'7/Cq�� = rn <br /> m <br /> I declare <br /> he this application (including any accompanying schedule) has been examined by me and to the best of my Ot C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of o <br /> all information contained 1n this application(including any accompanying schedule)and I further declare that I recognize po m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- o m <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 <br /> providing in this application. I agree to permit county officials charged with administering county or, <br /> or other m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> CD : <br /> 169 <br /> SIGN HERE <br /> 6 � oa <br /> (si ure of owner or buil g contractor) ` (d te) <br /> ZONING ADMINISTRATOR F»w Fn ce vw <br /> N Vt N N ul(Jt <br /> (r 03COP N OO <br /> O 0 0 0 0 0 0 <br /> UTOWNSHIP PERMITS MAY BE REQUIRED <br />