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Burnett Co ty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator Q o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> C401 W C 1d) GS 3--366q <br /> OWNERThan TELEPHErn�Qq_-5Q UD-3V <br /> 7 a <br /> ON <br /> je- <br /> O <br /> C7 vveirtAree Rumoe <br /> HOME ADDRESS eIt &14 <br /> 0 <br /> EMERGENCY/FIRE NUMBER f OS ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) C'sm l> 1 l7 �/U 67D6& /Zt <br /> DWELLING/BUILDIIN�G'lE GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ r m 0M <br /> TYPE OF PERMIT(S): Q <br /> FILLING/GRADING ❑ CAMPING UNIT SUBDIVISION ❑ <br /> N <br /> y I <br /> STRUCTURE/ADDITION USE: r Xa 0 <br /> (Ho a Cabin; Commercial B ness; Bedroom; Deck; etc.) I U <br /> BUILDING CONTRACTOR: E <br /> v <br /> nr <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81A X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m ~ <br /> n a <br /> In <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C O <br /> NORTH(N). (A o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <br /> 'R <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. <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. <br /> v � 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN Ct S <br /> NEEDED. This structure to be used as private residential <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW garage/storage only. Not to be used for human o <br /> CONDITIONS OF PERMIT: habitation. t <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 1 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. ��1/ �e, r_r S t1e, O re�'dies ff n C9 In M �� m <br /> J 'l"O 9 � 3 me `Ln _ .'0 <br /> 6. v 'W r o F. <br /> 76eI✓o % <br /> '6, ou re � . � � y . <br /> 7. ' o Ntij,< o -I <br /> _y .'O <br /> LD <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 62C <br /> knowledge and belief it is true,correct and complete. I acknowl l am responsible for the detail and accuracy of <br /> all information contained in this application(including any acc in scheduleEE <br /> her declare that I recognize CD CD <br /> that this information I am providing will be relied upon by th 11$yrngtt ietermining whether to is- O <br /> sue a permit. 1 further accept all liability which may be a res I of the County Gf4 u n this information 1 am <br /> providing in this application. I agree to permit county off_ <br /> I char ith a inistering u ty ordinances or other m <br /> authorized person to have access to the above described pr es at h� e s e for purpose of inspection. T <br /> mCD : <br /> _no <br /> SIGN HERE <br /> (signature of ow er r b ng c tr r) NV N { ,(d e) <br /> ZONING ADMINISTRATOR ,V ,YV / o/f L•7_�/1 <br /> " t 4 <br /> o(n to v+ <br /> N NV NN)NN Vt <br /> 07 Ut O Vt V7 O O <br /> TOW SHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br /> 0000000 <br />