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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator r m o �—o <br /> APPLICATION FOR LAND USE PERMITS �. <br /> r <br /> N � <br /> C <br /> OWNER TELEPHONE 7 a l,- <br /> ../�' <br /> HOME ADDRESS /D 7/ <br /> EMERGENCY/FIRE NUMBER ROAD NAME Z)V/L$ Z4F Pip/b <br /> V, kv0p 35F "k Tif/V5 r <br /> C$0 <br /> � <br /> LEGAL DESCRIPTION (see tax receipt) W p 3,5sy T/f E a43rs' 'r?l ,P71 cw 1.f :31:31:7 !J/ •/ •1 4 m <br /> Q <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION 11 PRIW ❑ rn <br /> TYPE OF PERMIT(S): v <br /> FILLING/GRAD NG ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> ' 1 � y. <br /> STRUCTURE/ADDITION USE: fH'f/fYIE 0 <br /> '' (Ho /Cabin; Commercial Business; Bedroom, Deck; etc.) � n rn <br /> BUILDING CONTRACTOR: j/VDd�IsGteV1L 112�5 (�BMIAle, M,AZ ✓-50— � 5, <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/]X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> 0 m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> T a <br /> In Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m W A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C (l n <br /> NORTH(N). rn O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. ( ,oZ <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. G <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. ,o o O1 <br /> v $ <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN S, <br /> NEEDED. q r <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P <br /> a <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT �I <br /> ISSUANCE. 1 1 <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 1 <br /> SETBACK AREA. /y <br /> 6. aQ.mcm '"o ' 3 <br /> 7. o : <br /> m <br /> m <br /> I declare that this application (including any accompanying sc "pen examined by me and to the best of my c <br /> knowledge and belief it is true,correct and complete. I ackno e ailhir ydpp�ggsible for the detail and accuracy ofm <br /> all information contained in this application(including any ac o a er declare that I recognize m m M <br /> that this information I am providing will be relied upon by th unty of ur c e ining whether to is- D <br /> sue a permit. I further accept all liability which may be a red If the qounty of Burn r i his information I am m <br /> providing in this Aplication. I agree to permit county offic4l chargh inistering ordinances or other m <br /> authorized pers9h tb lAve access to the above described premises at any ma tiftne fort lurpose of inspection. T `: <br /> M : <br /> SIGN HERE N a J J <br /> Ian ure of w e o dding contractor) � (date) <br /> ZONING ADMINISTRATOR Fa <br /> cn cn cn fn w fn <br /> N N(T N N V7 <br /> V7 Vt O Vt V1 O . O <br /> TOWNVP PERMITS MAY BE REQUIRED o 0 0 o a o 00 <br />