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«" Cdyyt� <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 /> r <br /> OWNER E/(//IS TELEPHONE (6 /Z) ( L1(–;7D.9 �l <br /> HOME ADDRESS la7�d /O�Cv11ZiNF �DF /y'�Y 5�� �/ V 9 <br /> r � <br /> EMERGENCY/FIRE NUMBER 6 :;6J-- ROAD NAME//Vp/171"'Aka Qlo 110 <br /> -3 g5' Y?5 7qS T 7SI75o9 ,j76 64_ ZW /, /T 35 -iy GorrLuT/�/ � <br /> LEGAL DESCRIPTION(see tax receipt) <br /> m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PIVY ' y 0 <br /> TYPE OF PERMIT(S): 'z o <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ S. <br /> STRUCTURE/ADDITION USE: � � n t o <br /> (� (Home/Cabin; Commerc Business; Bedroom;Deck;etc.) m <br /> BUILDING CONTRACTOR: J EL/- <br /> firv <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. W <br /> N <br /> DIRECTIONS FOR PLOT.PLAN DRAWING: (AERIAL OR TOP VIEW) T a <br /> TZ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m :? <br /> NORTH(N). <br /> 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. P <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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <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. o <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN Cr <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT O <br /> ISSUANCE. 1 U <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. I �, <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 /> m 3 ' N: m <br /> CL <br /> 6. v CDC <br /> n !" o �� S <br /> 7. Z : m fD < : _� i <br /> o : <br /> y: M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m <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- O <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 m <br /> providing in this app ion. I agree to permit county officials charged with administering county ordinances or other ; 3 E E <br /> authorized person to ha a acce%sle the aoAve described premises at any reasonable time for the purpose of inspection. -n <br /> m : <br /> SIGN HERE bb <br /> (signs r f owne ui n actor) r (date) <br /> ZONING ADMINISTRATOR Y 7 ` w <br /> v,v,e.40 4 <br /> N N N N N N N <br /> . Ut O N fT 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> 0000000 <br /> 0000000 <br />