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Vk�� <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator v G) Z <br /> APPLICATION FOR LAND USE PERMITS <br /> iTr n <br /> N 0 <br /> N <br /> W <br /> OWNER TELEPHONE Sao O <br /> IHOME ADDRESS <br /> r m <br /> 0 <br /> EMERGENCY/FIRE NUMBER �7 /YG ROAD NAME /VL.a Tn��lQl <br /> LEGAL DESCRIPTION(see tax receipt) p <br /> 10 �� V Z/ �it� a� ,6 1 (, <br /> N <br /> TYPE OF PERMIT(S): <br /> DWELLING/BUILDING El GARAGE/ACCESSORY STRUCTURE KADDITION ❑ PRIVY ❑ y o Cz <br /> CrC <br /> FILLING/GRADING ❑ AMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: o <br /> (Home/Cabin; Commercial Business; B room; Deck;etc.) C <br /> BUILDING CONTRACTOR:_S/��' _� <br /> 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. m ^. <br /> O <br /> M <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O <br /> CD <br /> -n a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. Z <br /> m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). C O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <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. 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 <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 /> c ' <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN q T <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: <br /> 0 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT Q <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 V <br /> SETBACK AREA.5. <br /> M fir 0� <br /> M m m gm <br /> m <br /> 'amcN !" > > 3 <br /> o <br /> CO <br /> I declare that this application (including any accompanA schedul xamined by me and to the best of my c p <br /> knowledge and belief it is true,correct and complete. I owledge tha ible for the detail and accuracy of m � C <br /> all information contained in this application(including an acco mg sc ,further declare that I recognize m m m <br /> that this information I am providing will be relied upon b e Coof Burnett s in determining whether to is- O <br /> sue a permit. I further accept all liability which may be a"rf the C of Bur dying on this information 1 am m i <br /> providing in this application. I agree to permit county offici ged wi miste rig,county ordinances or other m E <br /> authorized person to have access to the above described prem reas able t1 for the purpose of inspection. -n <br /> SIGN HERE <br /> (signature of o er or buil mg contrac (date) <br /> ZONING ADMINISTRATOR <br /> to to Fn Fn v+cn <br /> N N V I N N U I (r <br /> N ut O Ut Ut O O <br /> TO SHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />