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D) U`'"'"* <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 /> n CD <br /> c <br /> OWNER TELEPHONECD <br /> m <br /> HOME ADDRESS Gvl ���� 1 dLLiY1TD <br /> EMERGENCY/FIRE NUMBER �{�Y]�/ ROAD NAME / 'I U I���y� �b <br /> LEGAL DESCRIPTION (see tax receipt) M C' L life Sh/ 39 —�� � cn <br /> m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ rn 0 <br /> TYPE OF PERMIT(S): Q ' <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> N <br /> STRUCTURE/ADDITION USE: Ila l" ro C � ycc r ���F — ,C{^ e h /oF�/ o <br /> ll <br /> (Home/Cabin; Cgmmercial Business; Bedroom; Deck;etc.) Cn <br /> I m <br /> BUILDING CONTRACTOR: y iCD <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOTPLETE �� T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. Q <br /> z N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 1 v J t1� Oa <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 S <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. 1 0 <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 O <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. ( n 0 1 <br /> O 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN = o � <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: a 1 <br /> C <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. OQ <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY (1 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER (� <br /> SETBACK AREA. <br /> 5. <br /> m � oOi � 0CD0- * m <br /> 6. (OD � 3amOaT ;a <br /> -o' m C: 3 <br /> 7. on m 0 m M <br /> _ Cn : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my C) A <br /> knowledge and belief it is true,correct and complete. I ackn, wledge that I am responsible for the detail and accuracy of n <br /> all information contained in this application(including any ai. Ing schedule)and I further declare that I recognize ` <br /> o <br /> 0 <br /> that this information I am providing will be relied upon by t rnett Wisconsin in determining whether to is <br /> apermit. I further accept all liability which may be a r jC �t�e; Burnett relying on this information I am <br /> providing in this application. I agree to permit county ot�f'R Is charms Y4ifhd 1 i ring county ordinances or other <br /> authorized person have acc to th abov d cri ed'fi mises at an a e purpose of inspection. T <br /> m <br /> SIGN HERE <br /> (s' n u e of own or build/i cd", <br /> N r (date) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> (VSt> <br />