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NIC1 1" <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> y 0 <br /> N <br /> C <br /> /,� �^ ii <br /> OWNER TELEPHONE 5-Q7,L�j� �17S <br /> HOME ADDRESS �6 gS �Scr/�L J/ 6tA J#re>upA— t5l). -5-04 v <br /> r <br /> 0 <br /> EMERGENCY/FIRE NUMBER a� 3�c� ROAD NAME F 1A,)-AaS 4g,= zw, co <br /> I ~ <br /> G _ <br /> LEGAL DESCRIPTION (see tax receipt) <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION PRIVY ❑ ca <br /> TYPE OF PERMIT(S): v <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SU DIVISION ❑ C` <br /> A � ag�X��� N' <br /> STRUCTURE/ADDITION USE: �"1 6Y1 0 <br /> ome/Cabin; commercial Business; Bedroom;Deck;etc.) m <br /> BUILDING CONTRACTOR: L-�• � � s,�j,,, fii <br /> M <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> M H <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T c <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 'o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> NORTH(N). y 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO rn 3 <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. 190 P <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TOCT� c) <br /> BUILDINGS, ROADS,LAKE, LOT LINES. < <br /> 5. 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 T <br /> MUST BE SIGNED AND DATED BY THE OWNER. (00 1 <br /> o 9 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN a <br /> NEEDED. 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: 90I <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 /> zv0r � otam <br /> 6. 5' CDCuO�i o ' 3 <br /> 7. o NCD2 CP =i <br /> l € <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my t S c p <br /> knowledge and belief It is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of CL <br /> S <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- v <br /> sue a permit. I further accept all liability which may be a result of the County oSBnr <br /> providing in this application. I agree to permit county officials chargedwith c r other m <br /> authorized person to hav cess to the abov described gLemises at any rea o i ection. T <br /> m : <br /> m <br /> 4d� �SIGN HERE (signature of owner Ildl contractor) ) <br /> ;�' Iy <br /> ZONING ADMINISTRATOR jm i j' ( ; 4A 40 49 69 4 <br /> '- N Ntr N NN <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />