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'IrL <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> T m <br /> N O <br /> N <br /> C <br /> �s d <br /> OWNER ! -A.�(�l CCO�n/✓�7Z TELEPHONEGI?— <br /> HOME ADDRESSyr r114f-AA <br /> A <br /> o <br /> EMERGENCY/FIRE NUMBER ROAD NAME /'Y/A.l elye 'FD (- <br /> 5�c. 2S/ T 4Oe /f5ek 4/ C,>.� Uo aME/6 I <br /> : <br /> LEGAL DESCRIPTION (see tax receipt) / ,nF <br /> 6 f 2&L— <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ rn <br /> c v <br /> TYPE OF PERMIT(S): aO <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ �\ <br /> /A /> T. so 5 <br /> (� 9Riw/ N <br /> STRUCTURE/ADDITION USE: 0 <br /> (Home/Cabin; <br /> Commercial Business; Bedroom, Deck;etc.) Cn <br /> BUILDING CONTRACTOR: <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> M y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 o <br /> .n z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n d — 'p <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m U) <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 DO <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(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. XJ 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. �� 0 <br /> v ln31, <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q S 7-' <br /> NEEDED. 1z 0 <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 <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 a <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> zvc� � v vm <br /> mCuyi !ft o5' 3 <br /> COD o : o =j�� <br /> 7. Sri. m <br /> I declare that this application (including any accompariVing hedule) has been examinelif by me and to the best of my (j 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 <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 m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other CD <br /> 3 <br /> authorized person to have access to the abovq described premises at any reasonable time for the purpose of inspection. T <br /> CD : <br /> CD : <br /> q p to <br /> SIGN HERE116 o✓ <br /> (signal re o ro ulldi c (date) <br /> ZONING ADMINISTRATOR _ / Jl 69 <br /> vi to 4a Fn Fn fn <br /> NN 0 <br /> Vt U1Vt0 CnCA N0O <br /> TOWN HIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br /> 0000000 <br />