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64vm <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 64872 Office of Zoning Administrator v G) <br /> APPLICATION FOR LAND USE PERMIT 3. <br /> N � <br /> N <br /> 12 ><z� <br /> OWNER O 4J � OG-sa l TELEPHONE 6;3 <br /> HOME ADDRESS J / ' Z 67;// <br /> EMERGENCY/FIRE NUMBER 9)76 00 ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) 5EC z-9�-N 7 �� 17 u) n r3 as/o v z P 1 3 <br /> 12C Cxiy 1-0 r-/1or <br /> m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE © ADDITION ❑ PRIVY ❑ m <br /> TYPE OF PERMIT(S): c <br /> FILLING/GRADING ❑ CAMPING UNITE] SUBDIV E]ION 5 <br /> STRUCTURE/ADDITION USE: .2 CA ��t'Y J G� ATT A C H FO ^ <br /> - �/ (Home}/CCabinn; CommercialBusiness; Bedroom;Deck;etc.) 0) <br /> BUILDING CONTRACTOR: 3 F--PR/ <br /> _0CD <br /> 1 <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR '3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n0 O T <br /> M N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m r <br /> NORTH(N). CW n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO M <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 /> 6. 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. o LID <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q <br /> NEEDED. 2 p ' <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: o <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 O <br /> PERMITTED. v <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA<� —1 <br /> NG <br /> 5. h n. �N Muer � v�vv <br /> m <br /> CL <br /> a <br /> CD C01 !a <br /> 0 <br /> 7. 0 N (WD <br /> M <br /> o <br /> _m: m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my L7 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 m m m <br /> that this information I am providing will be relied upon by the�C��o-u�n of Burnett Wisconsin in determining whether to is- <br /> sue a permit. I further accept all liability which may I e a rg VS�W®r <br /> relying on this information I am o <br /> providing in this a cation. I agree to permit county offi. i I county ordinances or other m <br /> authorized perso to ave access the above scribed p r the purpose ofinspection. -n ; E <br /> m : <br /> y� m <br /> NAY <br /> SIGN HERE NA <br /> (si lure of owner or b I ng c tracctter) (date) <br /> ZONING ADMINISTRATOR <br /> ZONING <br /> N N(T N N(11N <br /> V7 VtO VtNOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED S o a <br />