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-o <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o' moo <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> - 0 <br /> y <br /> y <br /> C <br /> `� n <br /> OWNER �^\'hit ` J l��c�Q� TELEPHONE 7 0 <br /> ( Qo (� m <br /> HOMEADORESSa�IQ�a �. n �uM (/1�T 0p��O v 0 <br /> m <br /> EMERGENCY/FIRE NUMBER a g Co(oa ROAD NAME no <br /> W <br /> LEGAL DESCRIPTION(see tax receipt) 5 14 0 1 /Aa 5 LD n 1 m <br /> 2 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ rn o <br /> TYPE OF PERMIT(S): Q ' <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ / 5 <br /> STRUCTURE/ADDITION USE:_�t'I , a y _ �O� \' � O <br /> (Home/Cabin; Commercial Business; Bedroom; Dec c.) rn \ <br /> m <br /> BUILDING CONTRACTOR: <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. a m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m EF <br /> NORTH(N). y c <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 Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <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. 0 <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. So <br /> O 9 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN q <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT O� <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. r� <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY V1 <br /> PERMITTED. N-2) <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 6. �' � � - <br /> 3 o, R- 70 <br /> 3 n c <br /> v : <br /> COD Cvi '." a93 <br /> 0 <br /> o <br /> —ur: m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of a <br /> all Information contained in this application(including any accompanying schedule)and I further declare that I recognize . A <br /> r 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 1 am m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized pers n to have access the above described premises at any reasonable time for the purpose of inspection. -n <br /> m : <br /> SIGN HERE 5--a5-99 <br /> is n ure of own or buildin c tractor) (date) <br /> ZONING ADMINISTRATOR <br /> N N 01 N N N ()t <br /> (T U1 0 U1 fl1 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED a�� 9� o o n o o n <br /> c) C)C) 0 <br /> q <br />