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Burnett Caunty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator ' " v'o ' of <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> Q 1, O V <br /> OWNER I J A�!D TELEPHONE 7� �9a— 7�6 p <br /> N <br /> HOME ADDRESS W ► �y 8810 <br /> r � <br /> —7-- sGt1/55 7RA IL <br /> EMERGENCY/FIRE NUMBER ,2 j q(9 ROAD NAME 44�l <br /> Cn <br /> LEGAL DESCRIPTION(see tax receipt) `-yQ N R f 4( w .SEG, 10 0 ��Aly <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE 9 ADDITION ❑ PRIVY ❑ 0 0 <br /> TYPE OF PERMIT(S): rr <br /> FILLING/GRADING ❑f rCAMPING UNIT ❑y SUBDIVISION ❑ <br /> STRUCTURE/ADDITION USE: /'Wy)F CV40' �O 6AgA6r � E4� <br /> (Home/Cabin;;/Commercial Business; Bedroom; Deck;etc.) U <br /> T <br /> BUILDING CONTRACTOR: V rM r---4Z � <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 N <br /> G <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C c <br /> NORTH(N). y <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 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. lJ <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. 1 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN Ct <br /> 0 S <br /> NEEDED. �' ) <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c 0 <br /> CONDITIONS OF PERMIT: 9j <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 r, <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. x 'D 0r 090 � <br /> N M. N N 'E m <br /> 6< 3amOxa _;'0 <br /> 6. mCN `" oSZ <br /> 2 y m <br /> 7. ° : rn .� <br /> M <br /> I declare that this application (including any accompanying schedule) has be me and to the best of my 6, <br /> c <br /> knowledge and belief it is true, correct and complete. I acknowledge that I a I Is tail and accuracy of o E' <br /> all information contained in this application(including any accompanying edule)a r d that i recognize : m m <br /> that this information 1 am providing will be relied upon by the County of ett Wisconsin a n' )tether to is- d <br /> sue a permit. I further accept all liability which may be a result of the Co, of B relying on hi stion I am ; E <br /> providing in this application. I agree to permit county officials charged wt h admisirl my ordina a or other : m <br /> authorized person to have access to thqjabove described premises at any r ble time o t pose i spection. <br /> (D : <br /> SIGN HERE <br /> (signator ow er rb ' i c rector) O'Yi (date) <br /> ZONING ADM ISTRATOR <br /> Z' —�� <br /> N N (nNNEn0 <br /> V7 fT 0(n (11 0 0 <br /> O 0 0 0 0 00 <br /> OWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />