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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning AdministratorQ o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> gvaq..5 nolr'k <br /> OWNER ��Mbe.R�u-T GTELEPHONE 7 f S'(flSCo-3y t b <br /> m <br /> m <br /> HOME ADDRESS '66 116 P40!j.7 -7 -Zao bL,4-i-\c UJ r 54 8 v � <br /> m <br /> EMERGENCY/FIRE NUMBER 8� ROAD NAME �}!()t,�, 77 t <br /> Lai If 0-5nn V toPaLAB" Crn-Se 5e) � <br /> LEGAL DESCRIPTION(see tax receipt) j4je 4 Q17 w cly 0 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE El ADDITIONPRIVY El rn 0 <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPUNIT ❑ SUBDIVISION ❑ <br /> N <br /> S. <br /> STRUCTURE/ADDITION USE: d m� IN D <br /> (Hom abin; Commercial Business; Bedroom; Deck;etc.) W <br /> BUILDING CONTRACTOR: VIC_ <br /> W 1 <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81A 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <10 41 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> n o. <br /> T <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 :° <br /> NORTH(N). C w 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 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. so <br /> O 9 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN 0 C <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT Q <br /> ISSUANCE. o ' <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. L r <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 U. <br /> SETBACK AREA. <br /> 5. <br /> Xvc>r- oCD eov <br /> 6. �6 mc ' <br /> voCL. <br /> Z <br /> CMD <br /> 7. <br /> o : <br /> ern : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 3q C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m <br /> all information contained in this application(including any accWn0anying schedule)and I further declare that I recognize CD m <br /> that this information I am providing will be relied upon by tF) urnett Wisconsin in determining whether to is- O <br /> sue a permit. I further accept all liability which may be a r e aurnett relying on this information I am m <br /> providing in this application. I agree to permit county ials t ing county ordinances or other m <br /> authorized pe to have access to the aboltescrib emises at an a for the purpose of inspection. -n <br /> m : <br /> p ®o <br /> SIGN HE jut � <br /> (signatu owner or wilding qr) (date) <br /> ZONING ADMINISTRATOR ✓Irn lc't'jo <br /> Er'C <br /> �VIVZ <br /> N N <br /> V1 O P P N U1 O O N 0 <br /> V1 U1 <br /> S o 0 0 o aTOWNSHIP PERMITS MAY BE REQUIRED o <br />