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(T2,-t_ <br /> Burnett aunty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> N C <br /> y .r <br /> C <br /> OWNER /V2"."LEPHONE7,/6 5 <br /> O <br /> HOME ADDRESS <br /> EMERGENCY/FIRE NUMBER ROAD NAME SMELL L^/ <br /> �j <br /> LEGAL DESCRIPTION (see tax receipt) <br /> '_d 7 <br /> T <br /> r 1 f/ OwN e-r- AV,6eW?r111 <br /> o <br /> a <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY y <br /> TYPE OF PERMIT(S): <br /> v <br /> FILLING/GRADING ❑ CAMPING UNIT V SUBDIVISION ❑ S. <br /> S. <br /> r �- <br /> STRUCTURE/ADDITION USE: ��///��� f6-4 to ^0 47AV--06-7— 0 <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) N <br /> m <br /> BUILDING CONTRACTOR: <br /> v <br /> CD <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 /> O — <br /> .'0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 <br /> n TL <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 tJ <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 MAY BE DONE WHEN Ct <br /> " ° <br /> 1 <br /> NEEDED. 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: J <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 RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> ;a _0 onidioom <br /> 6. 3 0, a Fd m <br /> 7. Z : N (D <br /> o : <br /> =o" m <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 of m C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m'm : 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 <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 mixes at an reasonable time for the purpose of Inspection. n <br /> P Y P P P T E <br /> SIGN HERE <br /> (signature of owner or bu ding contractor) (date) <br /> ZONING ADMINISTRATOR <br /> N N N Pi 0`1 ut <br /> O (11 (100 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 <br /> 00000 <br />