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bffl��O <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> ifl✓F 2 (,I,[. FA-in i L _72k S7� J(� Q/ l <br /> OWNER anP,V G C� �IcFOIi?���u���E TELEPHONE �/c7 `/ `7 76 � t <br /> HOME ADDRESS .)�Jt J� �� F rZ RQ1 t4)E35t�2 � � �Lt?41.3 0 <br /> EMERGENCY/FIRE NUMBER p//(e� NAME <br /> LEGAL DESCRIPTION(see tax receipt) kOt(O CsmVol In/ n (�(p�Nt,� S+� `1_yU -��� m <br /> e <br /> E/ACCESSORY STRUCTURE A ITION 1:1PRIVY ❑ <br /> DWELLING/BUILDING 0 GARAG ° <br /> TYPE OF PERMIT(S): <br /> me FI�LIN / D//IN''G CAMPING UNIT ❑ SUBDIVISION ❑ -/ 5 <br /> STRUCTURE/ADDITION USE: HDA l jC i�Q f' a E d G/'�2N 6E AAIB/ ��1 X��1, '�- <br /> ,// (Ho a/Cabin; Commercial Bu ess; Be room; Deck;etc.) m <br /> BUILDING CONTRACTOR: LMC HD M F S4LF S `— / LoLE <br /> r <br /> ,15 L 6*7 to <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 N ...JJJ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) c <br /> n a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m ° J <br /> NORTH(N). ° <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO CO) 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF \ v <br /> 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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N O <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR,ETC.,THE PLANS t �. <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> O <br /> t <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. ^ /" <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT v <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 /> I <br /> A—.-2r z MM o? m <br /> m �. m � CD <br /> 6. F ° n�" �^ o g 3 <br /> R N O 79 <br /> 7. <br /> o <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Gt C <br /> knowledge and belief it is true, correct and complete. I ackno I am responsible for the detail and accuracy of �i o B A <br /> all information contained in this application(including any a a I I further declare that I recognize �(� m m m <br /> that this information I am providing will be relied upon by t I 4n determining whether to is- O <br /> sue a permit. 1 further accept all liability which may beak It of the o ih on this information I am m <br /> providing in this application. I agree to permit county o i als cha ed with adminis a unty ordinances or other E (D E ` <br /> authorized person to have access to the above described ises TarrAble time f the purpose of inspection. -n <br /> Le <br /> m : <br /> m <br /> SIGN HERE <br /> ( ign lure of o e ' g or buil contractor) NTy (date) h <br /> /Yt N c€ € ? <br /> ZONING ADMINISTRATOR vA cn to to w W <br /> � ,°NioN, ocEoo <br /> 0000000 <br /> TOWNSHIP PERMITS MAY BE REQUIRED c 0 0 c 0 <br />