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Burdett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 c) z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> VT O <br /> N <br /> CD <br /> OWNER TELEPHONE cj 5. -g6cl- -7 C <br /> (/O n <br /> 4Q n ►r� II M L o <br /> HOME ADDRESS g98g Cy�dt�- IC1NO.r k l,,j �riOrl.4.� I� w vr5d�� OTC <br /> r m <br /> 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME C o RA <br /> LEGAL DESCRIPTION(see tax receipt) Sec 214 m <br /> DWELLING/BUILDING X GARAGE/ACCESSORY STRULREX ADDITION ❑ PRIVY ❑ O <br /> TYPE OF PERMIT(S): v ' <br /> IN <br /> FILLING/GRADING X— CAMPING UNIT 1:1 SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: 60--vi <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) rn <br /> BUILDING CONTRACTOR: <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETOR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. �e // _ (� /I� Lp 0 N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) l /�U�I�.tJ Q O n <br /> n o z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m C <br /> NORTH(N). y 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. p <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. ry <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 t <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN T ° <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 <br /> ISSUANCE. w <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 /> X � v°r' QQ :Em <br /> 6. m 3 n m x- <br /> 7. <br /> Z : <br /> NO <br /> rp"60 jlkwer _. m <br /> - ^ ' ID <br /> I declare that this application (including any accole <br /> schedule) has been examined by me and to the best of my G) c C <br /> knowledge and belief it is true, correct and complevo that I am responsible for the detail and accuracy of a co C-all information contained in this application(includa hedule)and I further declare that I recognizem m <br /> CDthat this information I am providing will be relied u + onsin in determining whether to is- <br /> sue a permit. I further accept all liability which masult o th �y I����'rf��tji <br /> ?ing on this information I am <br /> providing in this application. 1 a ee permit coial charged w h rpt�il; county ordinances or otherCD <br /> authorized person to ve ac to th above dese t n reasonaTle r the purpose of inspection. <br /> n T <br /> O 1 CD <br /> N <br /> / 22 ^►� <br /> SIGN HERE BUR // V -0 <br /> owner Ing contr U U;' (date) <br /> ZONING ADMINISTRA <br /> TOWNSHIP PERMITS MAY BE REQUIRED ,i y <br /> l�J <br />