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bmw <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v G) z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> N <br /> C <br /> CD <br /> OWNER <br /> TELEPHONE J7- 2 80 -693N <br /> v <br /> OHOME ADDRESS A16 5t. fftliycdjT j%'j W'PJ C'4 fie., AAV Ss PO <br /> 00 m <br /> EMERGENCY/FIRE NUMBER G�Q S ROAD NAME F�%W✓J 6E L,�/U e I <br /> S3S/TPI /R� 4w ;- y/- f6- 3r--0 o26/D <br /> LEGAL DESCRIPTION(see tax receipt) t O cn <br /> Lar S Csa1 y i3 zst (Ga� /„fs 3 Y) CD <br /> atDWELLING/BUILDING ❑ ARAGE CCESSORY STRUCTURE ❑ ADDITION 1:1 PRIVY 1:1rn 0 <br /> TYPE OF PERMIT(S): Q <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> La. <br /> STRUCTURE/ADDITION USE: o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) C0BUILDING CONTRACTOR: /�/�� /4,47eo lea n <br /> z � <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8Yz X 11 SHEET OF PAPER. ANY INCOMPLETE OR CD3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m <br /> M N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C) m -� <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m S <br /> NORTH(N). C 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 S- 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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. f i <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN o <br /> NEEDED. 2 U� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z <br /> CONDITIONS OF PERMIT: <br /> 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ( CS <br /> ISSUANCE. I <br /> SU <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. C) <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> � vWr � CD vDav � <br /> � <br /> m <br /> Nmo -i <br /> 7. 0 . <br /> - N : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Gf c <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize RC1 m mN : CDm <br /> that this information I am providing will be relied upon ounty of Burnett Wisconsin in determining whether to is- <br /> sue a permit. I further accept all liability which may be` of Burnett relying on this information I am <br /> providing in this application. I agree to permit county i a t pg county ordinances or other <br /> authorized person to have access to the above describ d rem e o "`fo?,the purpose of inspection. m <br /> T <br /> N <br /> SIGN HERE <br /> (sig tur of ownero, uilding ontractor) (date) <br /> ZONING ADMINISTRATOR <br /> zoN, � 8: <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />