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/t Ct <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 0 Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> y O <br /> OWNER \���RZ a AN P— r 0Wl 4Vq TELEPHONE Ce I 4�— v 6o o <br /> m <br /> �7HOME ADDRESS ci O <br /> # �y <br /> EMERGENCY/FIRE NUMBER 2-73 1 ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) (ACL. &V LrjT3 <br /> rn <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE Pr ADDITION ❑ PRIVY ❑ 1 o) o <br /> TYPE OF PERMIT(S): c <br /> FILLING/GRADING AMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: mug G4a4GF- 0. <br /> (Ho a/Cabin; Commercial Business; Bedroom;Deck;etc.) Cl) <br /> BUILDING CONTRACTOR: n8-01r) I{ <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 17 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m =- <br /> W - O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> n S <br /> InZ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n 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 /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO mJ fl. <br /> 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. 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. <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 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. m c <br /> o 9 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q <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. <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. <br /> 5. <br /> X -ao� a <br /> d <br /> m �. � ma m <br /> 6. 30 <br /> 7. Z ' 0 N _10 i <br /> O : <br /> 1 Cn m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 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 /> (D . . <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize o <br /> C 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 d <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <br /> authorized person tolAve access o the abo ascribed premises at any reasonable time for the purposq of Inspection. T <br /> 1Q rn : <br /> l <br /> SIGN HERE l 4 <br /> (sign ure Qf owner or build) ontractor) (d te) ( <br /> ZONING ADMINISTRATOR <br /> cn w cn fn fn <br /> N NN to NN (71N <br /> ,� V7 (T O V7 ut O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED � I^ 0 0 0 0 0 0 0 <br />