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&t t'6 � <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. L ` <br /> H <br /> CL <br /> C <br /> OWNERv f f��©A) TELEPHONE -71 <br /> HOMEADDRESS ��1C7 Sr �II��/V 3 �1fCL� �aIC LtJ�S� � �nd% v r 0 <br /> 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME ' mk H`, <br /> ` I I �I 11j,, <br /> LEGAL DESCRIPTION(see tax receipt) `1�AUI Ia �lN— Set, <br /> DWELLING/BUILDING ElGARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY 0� � � <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING CAMPING UNIT ❑ SUBDIVISION ❑ °0 <br /> I N <br /> STRUCTURE/ADDITION USE: <br /> c (Ho a/Cabin; Commercial Business; Bedroom; Deck;etc.) rn <br /> BUILDING CONTRACTOR: a& E <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR In 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> �I N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> 2! o Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). N 3 <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. P <br /> 4. SHOW THE LOCATION OF THE WELL(1N),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO (3 <br /> BUILDINGS,ROADS,LAKE,LOT LINES. 19 <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 1 <br /> MUST BE SIGNED AND DATED BY THE OWNER. co c <br /> v 9 W <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN Cr <br /> W <br /> NEEDED. X/ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: _ W <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 /> ;a -Udd CD m <br /> 6. aC� '"o9' 3 <br /> 7. o m fDzil'c ' =j <br /> = i i i m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my tj c c <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 <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 <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. T <br /> M : <br /> SIGN HERE .✓ g' S— �� <br /> sign'attu(r�eof ow,nn or building contractor) (date) <br /> ZONING ADMINISTRATOR <br /> fn to fn w to is <br /> N N V1NN(llN <br /> U V1 O [T(T 00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />