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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> N 0 <br /> N <br /> N <br /> OWNER TELEPHONE _ o <br /> 'I Q A , m W� <br /> HOME ADDRESS a kin I I q LQ N F Ado, /-�C M O 66 MAL S�y�I7 v o f <br /> EMERGENCY/FIRE NUMBER <br /> oZ 88q ) ROAD NAME 7a 6SOK LA ILP Rd <br /> LEGAL DESCRIPTION(see tax receipt) <br /> /V tJ S 7 1 CD <br /> �� 1 is <br /> DWELLING/BUILDING 1K GARAGE/ACCESSORY STRUCTURE 1:1 ADDITION E] PRIVY ElQ to 0 <br /> TYPE OF PERMIT(S): it <br /> FILLING/GRADING ❑ CAMPING UNIT SUBDIVISIEln <br /> STRUCTURE/ADDITION USE: C aL 6 t rl 02 x 7 0 <br /> 0 <br /> (Home/Cabin; Commercial usiness; Bedroom; Deck;etc.) y <br /> BUILDING CONTRACTOR:��f.hlr-. <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR � <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> O <br /> m O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> c <br /> In <br /> T z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m z <br /> 2. IF <br /> SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). <br /> n <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 (r Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. o <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. 0, <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 > >((J) <br /> MUST BE SIGNED AND DATED BY THE OWNER. c <br /> o � I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN " o -,Z',`` <br /> NEEDED. 0 W <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o W <br /> CONDITIONS OF PERMIT: <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. n ` <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY I{J <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK{AREA. <br /> Q/ ` ` ^ <br /> 5. n ( — /`-S �1/ N n � vc�� po�ov <br /> 6. / /✓j,97/ m � 3 'ahm Win`-- M <br /> o : <br /> =c'j m <br /> I declare that this application (including any accompan ' chedule) has exam' y me and to the best of my �, �j c p <br /> knowledge and belief it is true,correct and complete. I at I am respon for the detail and accuracy of m C <br /> CL x <br /> all information contained in this application(including any acco i� le) urther declare that I recognize ` m m <br /> that this information I am providing will be relied upon by the consin in determining whether to is- v <br /> sue a permit. I further accept all liability which may be a result of the ty ,, "nrnett relying on this information I am m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> m : <br /> q60 SIGN HER . <br /> (signature of owner o uild g contractor) (date) Q <br /> ZONING ADMINISTRATOR �. . . . <br /> ' N N VIN N VI N <br /> cn cnocn lnoo <br /> TOWNSHIP TS MAY BE REQUIRED coy/ �o 0 0 0 0 0 0 <br />