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�lb <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 /> r n - <br /> OWNER GrGfaij L � �r 1 TELEPHONE kr37 Ot <br /> HOME ADDRESS S 0 7 G kGnW�o�J nQ 1ZP <br /> o <br /> EMERGENCY/FIRE NUMBER Z 73 o3 ROAD NAME NC), rh �hl ✓� <br /> LEGAL DESCRIPTION(see tax receipt) (j6✓ Lo-T $ S eG j S 0 A leme tUit-n �� l w m <br /> 0 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ rA 0 <br /> TYPE OF PERMIT(S): c <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ q <br /> Vl <br /> STRUCTURE/ADDITION USE: /Q-Cr-54ma 1 <br /> (Home/Cabin; Commepbial Business; Bedroom; Deck; etc.) m ^ 0 <br /> BUILDING CONTRACTOR: I—Av-tc/ 0200-r 7-c. 4 4 J) <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> � H <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 o <br /> o z <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). fn o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <br /> v <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 /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. nl <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. 2 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN Cr <br /> NEEDED. a <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o I' <br /> CONDITIONS OF PERMIT: Q <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. I <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY ( p <br /> PERMITTED. rvyl <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. x -00r � 0�Om <br /> m �. m � mn <br /> 6. ///�U-�f����--n----��,, Q <br /> 7. 57 <br /> o _ y: ` E m <br /> I declare that this application (including any accompanying sche I has6�x mined by mea do the best of my tic C <br /> knowledge and belief it is true, correct and complete. I acknowled hat I aNUpJn4bl�(tAftthe d i and accuracy of o <br /> all information contained in this application(including any accompan Ing schedule)and er de a that I recognize m m m <br /> that this information I am providing will be relied upon by the CountyMun =5 <br /> n In deter ng whether to is- O <br /> sue a permit. I further accept all liability which may be a result of the n this information I am m <br /> providing in this application. I agree to permit county officials charged "Ong county ordinances or other m <br /> authorized person to have access to the above described premises at any reasonable tirffb for the purpose of inspection. <br /> (D <br /> SIGN HERE ' /�� <br /> Ture of ow r builds contractor) (date) <br /> ` C <br /> ZONING ADMINISTRATOR <br /> N N N "N MN ul <br /> F»vrvrw <br /> N N <br /> N N O N(TOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br /> 0 0 0 0 0 0 0 <br />