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(� <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v a Z <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> N 0 <br /> C <br /> OWNERGG�G7Y�' TELEPHONE <br /> HOME ADDRESS �3/6 �(/�►-T�e�,,tJ 1�� I�� Ca-X4 7a <br /> r� <br /> 0 <br /> EMERGENCY/FIRE NUMBER g 3 7/6 ROAD NAME <br /> G.C'i S'D' 3 L S In V -7 /0 % A� <br /> LEGAL DESCRIPTION(see tax receipt),4o-T , 5,c,�s¢C' 01 <br /> {{�� -.-off /oT 2 Sec / <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVYEl ,ryry\\ Cn 0 <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT El SUBDIVISI.O.N/❑ // ©�t/�k//C�.��- 1v`1 n <br /> STRUCTURE/ADDITION USE: Alolr� C 7 a" a) Ulm P OZ?/X 7 7 � '� far <br /> /� (Home/Cabin; Commerc Business; Bedroom; Deck; etc.)l ( �/ m <br /> BUILDING CONTRACTOR:/SIL TCY_4;� T �-I0/ZI e S Fr//s Holne.-i �1/G / \ Alt <br /> SC e.YiQA/� No,x e. v <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. 0 - <br /> O y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 o K� <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE rn �? n <br /> NORTH(N). to 0 <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 <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. `L � <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. NJ� <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. o <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN Cr <br /> NEEDED. 2 <br /> 1 <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 <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 /> Uc� J �-- (P m . m m n m <br /> 6. no <br /> MCm 's° 09' 3 <br /> 7. 0N M� <br /> = N m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my (j c p <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize 7V M M ;z; <br /> Fri <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- p <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information 1 am <br /> providing in this application. I agree to permit counjV officials charged with administering county ordinances or other m <br /> authorized person to hav ccess to the above de!2&d premises at any reasonable time for the purpose of inspection. T <br /> M : <br /> M : <br /> SIGN HERE <br /> a ure\f owner or buildinactor) (date) <br /> ZONING ADMINISTRATOR <br /> . vrwwurA410 <br /> uN N(A N to OI <br /> n 0A 001 N O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 <br />