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t` <br /> Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 o 0 <br /> APPLICATION FOR LAND USE PERMITS <br /> 1?��Sr:le�b�_� r <br /> N <br /> _ �f // al <br /> OWNER QTELEPHONE e( q ` n <br /> 0 <br /> v <br /> O <br /> HOME ADDRESS Z �j Z l eJ• ( k. .� ll� 0 <br /> T rn <br /> EMERGENCY/FIRE NUMBER ROAD NAME k � , / , <br /> LEGAL DESCRIPTION(see tax receipt) ��t-" ►�/ 1 (o p /L �p�y �® 7 QJ <br /> v / I 17) <br /> o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE 1-1ADDITION ❑ PRIVY El <br /> 1Z C <br /> FILLING/GRADIN/G E] CAAMPI G UNIT ❑ SUBDIVISION ❑ 1 l J W CL , <br /> STRUCTURE/ADDITION USE: l CSI� S-f 9Jr� � f�rl L/�/�l,J 0 <br /> (Home/Cabin; Com-m--ft-A Business; Bedroom;Deck; etc.) <br /> BUILDING CONTRACTOR: ::S9 I-V 1 <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 6'/a X 11 SHEET OF PAPER. ANY INCOMPLETE OR m <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O 3 <br /> � w <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> n a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m n <br /> NORTH(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 /> 6. 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. o <br /> o � ) <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN a <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: 0 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT Q <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,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. O <br /> 5. � <br /> 047 M�1� �1 W oo <br /> � m <br /> 11 M 'V0r <br /> 74 <br /> 6. <br /> 7. / c :H <br /> I declare that this application (including an a o m <br /> pp (' g y panying schedule) has been examined by me and to the best of my � IS <br /> knowledge and belief it is true, c rrect and j1h p e. I acknowledge that 1 am responsible for the detail and accuracy of c c <br /> all information contained in this pplicationclu ng any accompanying schedule)and I further declare that I recognize m m <br /> that this information I am provi i g wi ed pon by the County of Burnett Wisconsin in determining whether to is. O <br /> sue a permit further accept a liab'ity m y be a result of the County of Burnett relying on this information I am providing in is application. I gr to ait ounty officials charged with administering county ordinances or otherauthorized pe to have acce t bscribed premises at any reasonable time for the purpose of Inspection. -n <br /> m : <br /> CD <br /> SIGN HERE Z7 <br /> caner or bullding cont or) (date) (� <br /> ZONING ADMINISTRATOR C/ 1. . . . . . to <br /> v+www�n cn� <br /> cm vnPPNi�99 <br /> TOWNSHIP PERMITS MAY BE REQUIRED /0 00 c 0 000 0 <br /> 0 <br />