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Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator _U 7 Z <br /> APPLICATION FOR LAND USE PERMITS <br /> r <br /> OWNER 4^ Kti ` ELEPHON <br /> HOME ADORES �2�'' � I� I1 f a#.Li� F IGx Y��r7;.. LC� ���"�fe� `�v r O <br /> CD <br /> CDO <br /> EMERGENCY/FIRE NUMBER <br /> l010-:5i"es Ju ROAD NAME Q ~ <br /> LEGAL DESCRIPTION(see tax receipt) LoT I CSM V) to (D. CD <br /> t <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION PRIVY ❑ Q Cn <br /> TYPE OF PERMIT(S): a raves f Spat it <br /> FILLING/GRADING ❑ PCAMPING UNIT 11SUBDIVISION ❑ <br /> STRUCTURE/ADDITION USE: `'rte � C 0 <br /> d ( H m . <br /> e/Cabirl��ommercial Busi ss; Bedroom; Deck;etc.) c <br /> BUILDING CONTRACTOR: (/ /� t mle 5=_ LIlal <br /> m <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8Y:X 11 SHEET OF PAPER. ANY INCOMPLETE OR m� <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> M io <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 m <br /> n a <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T0 z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE IT T <br /> NORTH(N). C 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 J z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. q 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. Q N <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. O <br /> v <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN o <br /> NEEDED. .I <br /> kA <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o rN <br /> CONDITIONS OF PERMIT: 5 0 <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. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. U1 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK. <br /> 5. �^/� n <br /> Esc /-33 �l O+ K <br /> (D (D Ick. v v <br /> M <br /> 6. m 3 am x ° <br /> 7. Z ^ mo 1 <br /> m <br /> = rn : A <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 2 <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m0 m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize p <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> sue a permit. I further accept all liability which may be a result of the County rmation I am <br /> providing in this application. I agree to permit county officials charged wi i 3er <br /> o a or other <br /> authorized erson to hav access to the above describ d remises at an n Ite r i mp P Xpection. T <br /> W : <br /> co <br /> SIGN HEREug <br /> 64 QLCA.)V,9'f <br /> p <br /> (signa ure f owner r it mg contractor) 'I i SEP , (date) <br /> `� , <br /> ZONING ADMINISTRATOR V I 1 ° <br /> ZONING <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />