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0 TAe <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator _U 0 Z <br /> APPLICATION FOR LAND USE PERMITS �� 3. � P <br /> LIv o <br /> OWNER 'C`CPHON &_S-/ -7 <br /> HOME ADDRESS <br /> EMERGENCY/FIRE NUMBER 2-732K ROAD NAME � - — o ( —avl) <br /> LEGAL DESCRIPTION(see tax receipt) 0;20 q 33 3Qy 3oo a' -1310 y <br /> 1 m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION PRIVY ❑ ® r�" o <br /> TYPE OF PERMIT(S): N c� <br /> FILLING/GRADING ❑ CAMPING UNIT ❑`S_UBDIVISION ❑ vJ y <br /> STRUCTURE/ADDITION USE: C� i n �Pcr<ir� �o .1 kl 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck, etc.) ti <br /> BUILDING CONTRACTOR: r�YY1 ///u✓► — �IGt ���— r <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'h X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 A <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. qj �� _ a y (� fi��J 0 G <br /> XI N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) _� 0� m" a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. Z <br /> M CD <br /> v :b2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 1 0 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF S <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. o_F <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 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. = o <br /> o 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHENq 0, <br /> NEEDED. 0 W <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z C <br /> CONDITIONS OF PERMIT: c <br /> l <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT C <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 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> Mv0r0 <br /> 6. 0 <3 n m F n <br /> LD. c a m m e — <br /> m c� o 3 <br /> 7. Z " (WDzipl <br /> o o h <br /> o <br /> o' m <br /> I declare that this application (including any accompan 7result <br /> � en examined by me and to the best of my 6 c : O <br /> knowledge and belief it is true,correct and complete. Ie to a 5ponsible for the detail and accuracy of � m 0 C <br /> rr M <br /> all information contained in this application(including gculef d I further declare that I recognize m m <br /> that this information I am providing will be relied up ounty o rn V{Fih6in in determining whether to is- �1 i i O <br /> m <br /> sue a permit. I further accept all liability which may f the County of Burne relying on this information I am : m <br /> providing in this application. I agree to permit cough lLed i� minis ring county ordinances or other m <br /> authorized person to ave access to the above descri premises at an r at for the purpose of inspection. <br /> mCD : <br /> _ BURNECD <br /> SIGN HERE TT COUNTY <br /> 3 oU <br /> (si re of owner or buil ' contract date) <br /> ZONING ADMINISTRATOR <br /> t» vi w to an W <br /> (/ <br /> 41 <br /> . l N N P N N(T N <br /> TOWNSHIP PERMITS MAY BE REQUIRED , 00 0 0 0 0 0 <br /> '100 0000000 <br />