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oltump <br /> Burnett-:ounty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITSCL <br /> y <br /> �2�s TU N TELEPHONE SGj— 2 83 <br /> OWNER 6 <br /> gN d ,\ <br /> HOME ADDRESS Q, i30)( L� 1 m `W <br /> o <br /> ROAD NAME <br /> EMERGENCY/FIRE NUMBER Z q <br /> �cv <br /> 7 /J-217 3 D-/6 <br /> LEGAL DESCRIPTION (see tax receipt) �r� T _ o <br /> (ADDITION 11 PRIVY ❑ c <br /> DWELLING/BUILDING ❑ ARAG CCESSORY STRUCTURE LJ <br /> TYPE OF PERMIT(S): S. <br /> FILLING/GRADING 11 CAMPINGUNIT ❑ SUBDIVISION ❑ o <br /> STRUCTURE/ADDITION USE: <br /> G4 fz •9-C., 01�X y y <br /> (Home/Cabin; Commeraal Business, Bedroom,Deck,etc) <br /> BUILDING CONTRACTOR: <br /> v <br /> m _ <br /> 3 <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8Yz X 11 SHEET OF PAPER. ANY INCOMPLETE OR O — <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> O n <br /> DIRECTIONS FOR PLOT PLAN DRAWINNC: (AERIAL OR TOP VIEW) T o Z <br /> 0 m <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> C .. n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE y 3 <br /> NORTH(N). TO m <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(,)TO ALL LOT LINES, R BUILDING(,) ) <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF o <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. n` <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. N <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILL , -4 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS C , <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 g <br /> NEEDED. Z <br /> P , <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: R <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT W <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, <br /> WALLS,ETC/..I,ALLOWED WITHIN THE REQUIRED A <br /> TER <br /> SETBACK AREACCJ�v <br /> vAf� v� O3r�icu � a <br /> -m <br /> 5. ArmorU tV N N <br /> N CN o <br /> Z <br /> "6. .30. <br /> _ <br /> T i mt <br /> 7. <br /> I declare that this app;icstion (inclu i and compiete.ng aal acknowledge that 1 am responsible for he deta I and accuracy onying schedule) has been exami n f n C <br /> knowledge and beliiny 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 Wisconsin in determining whether to is- <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information I am <br /> ring county ordinances or <br /> providing in this application. I agree to permit c my officials charged <br /> reasonable time or the purpose owith administe f inspection. - <br /> authorized person to have es tort b des <br /> 8- 3/-O© <br /> SIGN HERE (date) ? E <br /> (signature o er or building co a or) <br /> ZONING ADMINISTRATOR N N(T N N <br /> cn cnolncnoo <br /> 0000000 <br /> T NSHIP PERMITS MAY BE REQUIRED <br />