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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 <br /> N � <br /> N <br /> C <br /> \� /ITELEPHONE <br /> OWNER V Ln tz �C LTJ o <br /> MAILINGADDRESS kdCD <br /> PROPERTYADDRESS <br /> X93 C far C <br /> 1 <br /> LEGAL DESCRIPTION(see tax receipt) L OC <br /> / / 4M I U) <br /> m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION � rn ° <br /> TYPE OF PERMIT(S): C <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑p n <br /> STRUCTURE/ADDITION USE: �J �.��f/(U ! -LT ZT7Y] ✓7N D �� ° �p <br /> (Home/Cabin;tommercial Bus' ss;Bedroom; eck;etc.) <br /> BUILDING CONTRACTOR: <br /> Z � <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> T <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 3 m ;b <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <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. r 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. <br /> 5. 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, BUILDER, CONTRACTOR, ETC., THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. f 1 <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: p t �. <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT vl� <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY 1 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> m W10> afren <br /> 6. 3 am xa ;M0ry C y y 0 <br /> 7. Z N O <br /> i x <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G7 c � C_ <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m 0 : v, <br /> CL u, ; <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m 0 : mo <br /> that this information I am providing will be relied upon by the Cou ping whether to is- <br /> sue a permit. I further accept all liability which may be a result o i information I am m <br /> providing in this application. I agree to permit county officials c e I inances or other <br /> authorized pers ave access to the above described premise t any reasonab a time frorthe r se of inspection. fD <br /> -nr� ry+,r� o <br /> SIGN HERE JUL 3 G 2110 o ° <br /> sur o r or building contra t ate) <br /> ZONING ADMINISTRATOR BURNETT COUNTY (� <br /> ZONING <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />