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Burnett-ounti 7410 Co. Rd. K, No. 102, Siren, 8 <br /> APPLICATION F WI 54872 Office of Zoning Administrator v <br /> OR LAND USE PERMITS "S <br /> OWNER O <br /> 0 I <br /> ff N e I 1 Q1� c <br /> n � � � n" TELEPHONE ��� _'� n � <br /> 1 <br /> HOME ADDRESS OC -'_-•'— v <br /> d4 ttsyN <br /> EMERGENCY/FIRE NUMBERd r°r 9 <br /> USI.] ROAD NAME �pQ n <br /> LEGAL DESCRIPTION(see tax receipt) ^ l I <br /> Cn <br /> DWELLING/BUILDING X GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ O m <br /> TYPE OF PERMIT(S): r, <br /> N <br /> 0 <br /> FILLING/GRADING 0 CAMPING UNIT ❑ <br /> SUBDIVISION ❑ c <br /> STRUCTURE/ADDITION USE: <br /> N <br /> (Home/( abin; Commercial Business; Bedroom;Deck;etc.) o <br /> BUILDING CONTRACTOR: <br /> w ' (� <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'%X 17 SHEET OF PAPER. ANY INCOMPLETE OR - <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 3 <br /> T — <br /> DIRECTIONS FOR PLOT PLAN DRAWINGO <br /> (AERIAL OR TOP VIEW) m <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. O a <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m Z <br /> NORTH(N), m v <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <br /> p <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO Z <br /> BUILDINGS,ROADS, LAKE, LOT LINES. <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILD R,CONTRA TOR,ETC.,THE PLANS o <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> \� o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN 0 <br /> NEEDED. <br /> CZr <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. T <br /> QNDITIONS OF PERMIT: Z Q <br /> 0 <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 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 6.6. /-r�-�.a— <br /> Q )/� L ' N C m <br /> 7. l v U t cT Q J/ / (_ J fD C N y _O <br /> �J Z ; N CUD, <br /> : 1 <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my o of 'r M <br /> M <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of iu " C <br /> all information contained in this application(including any acc <br /> declare that I reco <br /> that this information I am providing will be relied upon by the urn I gnize <br /> a . <br /> r^ m o <br /> sue a permit. I further accept all liability which may be a resul ning whether to is- m <br /> providing in this application. I agree to permit county official arged with administering c e el is informatI am <br /> C <br /> authorized perso ve access to the above described prem at an <br /> dinancesor other <br /> y o ble t' r the u ose of inspection. <br /> m <br /> SIGN HERE 1 / m <br /> _Q <br /> (signature of owneru ding contractor) ou <br /> ZONING ADMINISTRATOR (date) <br /> TOWNSHIP PERMITS MAY BE REQUIRED N N (n N N <br /> V10(T (71 <br /> (\O 0 O O O O <br /> 00000 <br /> ISE <br /> 4 <br />