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(qA <br /> Burnett ounty 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 /> N O <br /> N <br /> C <br /> OWNER 16 rn t1 i e, IS' TELEPHONE 6 S� My n <br /> 1 <br /> HOME ADDRESS / "16)Q L /h C D J� (,� V ST f'ao n IV MoI 011�-. <br /> r <br /> EMERGENCY/FIRE NUMBER ROAD NAME Ilt'CIQ,L✓2V o <br /> LEGAL DESCRIPTION (see tax receipt) �Ov ��)% / J J G -T 6 it/ `{ on <br /> DWELLING/BUILDING X GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ v ~ <br /> TYPE OF PERMIT(S): v ' <br /> FILLING/GRADIN]G�❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> STRUCTURE/ADDITION USE: /Y� (.✓ /��G� \ N <br /> (Home/Cabin; CommZ <br /> ' I Business; Bedroom; Deck; etc.) o <br /> ,lo�ih (.,�r1�c, a ��eY_s1�� G�hS-7 ',tjC C�h <br /> BUILDING CONTRACTOR: ` m <br /> m <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. �iv( 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) <br /> ( 6 n a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. S e� T z <br /> n m � <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m 1D <br /> NORTH(N). y of <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. (� 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 U 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. 1 o <br /> Q O � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a <br /> NEEDED. U`o <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: 0 <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. -4) <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. �O <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER ` <br /> SETBACK AREA. / / <br /> s. -v°r ggwC b e- `� 4A- e Sade c� Xuwli�s4.. <br /> �D �/� gyp// CD W 0 CD a f m <br /> 6. ' /� (�Ge �r/bli o 'DCm '°` o ° 3 <br /> N N <br /> 7. Zi CD <br /> 7. ' ° <br /> o T < M <br /> on : A <br /> I declare that this application (including any accompanying dule) a by me and to the best of my G1 c <br /> knowledge and belief it is true, correct and complete. I ack dge that I am res n ' detail and accuracy of o i �' A <br /> all information contained in this application(including any pany chedulee a f de lare that I recognizeID m <br /> that this information I am providing will be relied upon by the ounty or Wisconsi a ining whether to is- <br /> sue apermit. I further accept all liability which may be a resu e Count?' tt relyi o this information I am ° <br /> providing in this application. I agree to permit county officials it <br /> adrt firing u ordinances or other o <br /> authorized person to hav access to the above d c ibed premises at r able time fo urpose of inspection. <br /> m : <br /> SIGN HERE <br /> 2,. "zNc "rr a 4 <br /> gn re o n r building contractor) (date) :dp <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED V <br />