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6ml�' <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 /> 81b --733S) (�5l" � 'lqS3 r <br /> 0 <br /> N <br /> C <br /> �f�' �j,,�/ <br /> OWNER -1` �'L l t.'1v �� I/ t � 1'��G�+ TELEPHONE �� •"�jg����j2Z ^° <br /> HOME ADDRESS MEWdOA' t /14(-j o <br /> EMERGENCY/FIRE NUMBER 4 57Q ROAD NAMEWN" , 1 w <br /> L-0-1— 2� 06M -7a-9—ZSb ) Pqt4j4-tT— eo- W/ <br /> tco <br /> LEGAL DESCRIPTION(see tax receipt) <br /> e <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ c 0 <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING U ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITION USE:��►R� i�i A <br /> w/gypOR (Home/C 'n; Commercial <br /> business; Bedroom; De C <br /> k;etc.) <br /> NO��✓ <br /> BUILDING CONTRACTOR: fLigme 7�S` uR ' 32r1 <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 61/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 H G <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 o <br /> f1 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C <br /> CD <br /> NORTH(N). O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m �3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF (A , <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 I <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 ?. \� <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q <br /> NEEDED. This structure to be used as private residential w <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW garage/storage only. Not to be used for human c <br /> CONDITIONS OF PERMIT: habitation. <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 1 a <br /> ISSUANCE. is- <br /> 2. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY 9 f <br /> PERMITTED. (� <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER ^vim <br /> 5 S A <br /> ACK ARE � ) _ <br /> �i ,(1" �d� (D lbd Hm <br /> nHCL <br /> 6. L, <br /> 7. OZ ( rn: m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G) C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of n <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m M <br /> M <br /> that this information I am providing will be relied * County of Burnett Wisconsin in determining whether to is- l7 <br /> sue a permit. 1 further accept all liability wh�ch ay '/0s`r-0 of the County of Burnett relying on this information I am m <br /> providing in this application. I agree to percounty d�'ti�l ' arged with administering county ordinances or other m <br /> authorized person to have access to the atescn d pr At,any reasonable time for the purpose of inspection. -n <br /> j CD <br /> C . <br /> SIGN HERE <br /> ae <br /> signature � ing co a v 1 (date) <br /> f n <br /> ZONING ADMINISTRATOR d.cn cp to ui fn`� <br /> N NNNN Nut <br /> ,,////// N (nO VAf om <br /> TO SHIP PERI S 611,&YBE-REQUIRED &0 000000 <br />