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6-n <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 ci Z <br /> APPLICATION FOR LAND USE PERMITS 3 4 <br /> - r <br /> w o <br /> N <br /> OWNER TELEPHONE m <br /> 4oa4 tit pis S -Ao- ✓iu,- La-k-e Aml Ss3 °1 <br /> HOME ADDRESS9.J o2/ (�u r�j,4�� <br /> EMERGENCY/FIRE NUMBER 9 ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) Sad/t3�/.Pi 1L�1.4G�.t -$moo �pG,� �vG <br /> — —/7 .2/—O o7 AO m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION K PRIVY ❑ V) <br /> TYPE OF PERMIT(S): it <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ m <br /> b'"/ADDITION USE: �1D/77� ��C'7� <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) m <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. <br /> 70 H Y•-N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> In o. <br /> -n 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 <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 <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 <br /> BUILDINGS,ROADS,LAKE,LOT LINES. v <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 0 CD <br /> MUST BE SIGNED AND DATED BY THE OWNER. ,� c <br /> o � 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN <br /> Cr <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c ) <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <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 RETAININ L , ET .,ALLOWD ITHIN THS REQQ�TER <br /> 5. SETBACK AREA. L,//�Cj <br /> OM <br /> 6. �' � 3 n R- <br /> a - ;a <br /> C N N o _ <br /> � A: C N V <br /> ' 7 <br /> 7. Z0 : ZM <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 ofm C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize n <br /> N ' ' ' m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- l7 <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 to <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection, m <br /> m <br /> pp m <br /> SIGN HERE <br /> (signature of owne or bui i co r (date) <br /> ZONING ADMINISTRATOR '• . '• . ` <br /> 11� V*� <br /> NNW NZN VIN <br /> /.I/ ,VI V1 O V1 VI O O <br /> TO NSHIP PERMITS MAY BE REQUIRED o o o o o 0 o <br />