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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 G) Z <br /> APPLICATION FOR LAND USE PERMITS 3, <br /> N <br /> OWNER �YY�C 5 am 1 .IflnlP �1 'tk�V l�J TELEPHONE <br /> HOME ADDRESS ' /�� (? 1 <br /> EMERGENCY/FIRE NUMBER ! �(� � ROAD NAME l�h(1Lira- <br /> LEGAL DESCRIPTION(see tax receipt) tory see— IVdW <br /> -r I.� y <br /> /V m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ y o <br /> TYPE OF PERMIT(S): i <br /> FILLING/GR11�ADD��INnnG YY❑ CAMPING UNIT ❑ SUBDIVISION ❑ 5 <br /> STRUCTURE/ADDITION USE: c <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) or <br /> m <br /> BUILDING CONTRACTOR: <br /> irM <br /> M <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> m <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 3,0 <br /> �i N <br /> O m <br /> In a <br /> 1. 0 m 'A <br /> 2. m <br /> c a <br /> M 3 <br /> _ v <br /> Z <br /> 0 <br /> 5. INDICATE! 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. m c <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: P <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. gn5i�e. /U" dal-K Cc u-10(1 <br /> ;a -0 V <br /> �d D�O <br /> 6. be- o. R a o Q <br /> Z <br /> cr m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my i p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of Z ` i : c <br /> CL <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to <br /> sue a permit. 1 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 application. I agree to permit county officials charged with administering county ordinances or other a <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. T <br /> r��/!/` e <br /> e <br /> SIGN HERE 40 ' <br /> (signature of ow r or building contrac ) (date) <br /> ZONING ADMINISTRATOR <br /> 40 <br /> N N (11NN(TN <br /> N fJO (J1 V7 O O <br /> TO SHIP PERMITS MAY BE RE UIRED <br />