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�Ynclmy <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> N O0 <br /> N <br /> TELEPHONE1�Q�N�, <br /> O" 1 <br /> HOME ADDRESS �� t; V W.S f 4v SSS/� <br /> M <br /> M <br /> EMERGENCY/FIRE NUMBER 3 S S ROAD NAME <br /> N;�fm�y �z- SQ 342/yq QP C-'-- Sri/S, l� . o,230p <br /> Cn <br /> LEGAL DESCRIPTION(see tax receipt) W716 q 7 S 12 '1/ I.5J✓ COJ � IY5 -Z It-3 (41/ � <br /> ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ C o <br /> DWELLING/BUILDING c 25 <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAM ING NIT ❑ SUBDIVISIONT.❑ <br /> STRUCTURE/ADDITION USE: <br /> X ah a q� = <br /> (Home/Cabin; Commercial Business; Bed m; Deck;etc.) (n <br /> BUILDING CONTRACTOR: 6 LU <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81h X 11 SHEET OF PAPER. ANY INCOMPLETE OR .n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 a, <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n n <br /> T <br /> :E! <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE M a <br /> NORTH(N). m 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO <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. <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 ?, <br /> MUST BE SIGNED AND DATED BY THE OWNER. ° f <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN S SU <br /> NEEDED. <br /> Z �1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. ° <br /> ti <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT d <br /> ISSUANCE. I <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. t1 <br /> So <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY 3U 1I`1 <br /> PERMITTED. �+ <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. w v a m a f m <br /> o 3 am 0, am ;UD. = 3 <br /> 6. �o m0 " oma <br /> n o <br /> Z : <br /> m <br /> 7. <br /> °' ` A <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G) <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of \ a � <br /> N m <br /> A <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m <br /> that this information 1 am providing will be relied upon by the County of urnett Wisconsin in determining whether to is- G <br /> sue a permit. I further accept all liability which may be a result of the Cqunt ink on this information I am <br /> providing in this application. I agree to per it county officials charged'�r�gt a� is i c p"s or other m <br /> authorized person to have c ss to the ab a desc ibed premises at an �rkk r r f' pection. m . <br /> CD : <br /> SIGN HERE PR 11 <br /> (si ture of own or building contractor) (dat <br /> ZONING ADMINISTRATOR I ~ BURNIE <br /> ZONING 'j <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />