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�42C,bYy� <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,W154872 Office of Zoning Administrator T 0Z <br /> APPLICATION FOR LAND USE PE MITS M. <br /> lin <br /> 16 <br /> OWNER C L&� 7 z E 0C TELEPHONE n <br /> - 7/.s-�f - > <br /> HOME ADDRESS �� E �sTE K ' v' � <br /> r n <br /> EMERGENCY/FIRE NUMBER 31 J—! Z ROAD NAME �' ��E�J /0 R(7 4t <br /> ) <br /> LEGAL DESCRIPTION(sea lax receipt) I c V 't JOT Spm_ tl 3 �r <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ® ADDITION © PRIVY o - <br /> TYPE OF PERMIT(S): ) o <br /> FILLING/GRADING ❑ CAMPING UN SUBDIVISION ❑ n <br /> `` Z <br /> V <br /> STRUCTURE/ADDITION USE: C'4( 'E, r� ( � �- LA. <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Id C y <br /> BUILDING CONTRACTOR: r <br /> M <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR I <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 <br /> -n G <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICA m flo <br /> NORTH(N). C <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m ll v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF V <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 1 c <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. 1 <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS O r <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN 0 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 1 <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. In�• <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY XJ <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER d <br /> V` <br /> �SE�TBBACK AREA. <br /> 5. l)/ '�J_F— pp <br /> a � mdrDi �a£ m <br /> 6. is v� B ii);p �ra_m . <br /> a ry C y v C <br /> 7. Z : y m Yo a7 <br /> O <br /> gI declare that this application (including any accompanying schedule) has been examined by me and to the bast of my C)2 <br /> knowledge and belief it is true,correct and complete. I ack wledge that I am responsible for the detail and accuracy of A <br /> all Information contained In this application(including any Ing schedule)and I further declare that I recognize <br /> that this information I am providing will be relied upon by t tt Wisconsin in determining whether to is- <br /> sue apermit. !further accept all liability which may bear C u tt relying on this information I am v <br /> providing in this application. I agree to permit county o i Is char my ordinances or other <br /> authorized person to have access to the above described Ises at any re a ti purpose of inspection. 0 <br /> i <br /> M <br /> SIGN HERE - -- 7— ® '^ <br /> (signatur o nor or bullg co / (date) <br /> ZONING ADMINISTRATOR <br /> TO SHIP PERMITS MAY BE REQUIRED <br /> V <br />