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6X Go77� <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,W154872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> -71 15-- ?Gte—g07 � o <br /> OWNER To �� N/� rJ O Pr. C/�I TELEPHONE �+ —. 5�� )1 Q 6 0 <br /> HOME ADDRESS fr <br /> p `' O <br /> dOZ :�'NJt2 4"jc.. c,f 1,"i. ItiAjS '7 <br /> EMERGENCY/FIRE NUMBER Z -7 -7 5— 1 ROAD NAME E,Z 4 4:1 v rn <br /> LEGAL DESCRIPTION(see tax receipt) sir C /4•'C (1 y �— <br /> t+-e-dc- m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ® ADDITION ❑ PRIVY ❑ c o <br /> TYPE OF PERMIT(S): <br /> Cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ 5 <br /> N <br /> STRUCTURE/ADDITION USE: 0.g­fJ. <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: t'_0 N <TILtw C_,r'►p N <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3, <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> M <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) O a <br /> 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 rn 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 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. U 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. N I <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. c <br /> o 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a 0, <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: <br /> I <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 /> ;av0 r.- <br /> CD m <br /> 6. a <br /> v y y <br /> CD C <br /> 7. Zi `" fD� <br /> o : <br /> �1 Vl : <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 d c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize : 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 w' <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 /> CD <br /> m : <br /> Z <br /> SIGN HERE <br /> signature of owneror wilding contra r) (date) l <br /> ZONING ADMINISTRATOR J • K <br /> �K)LnNviMC" <br /> (� p O fly p O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> 0000000 0 <br />