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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 � ���'G <br /> Office of Zoning Administrator v v )z <br /> APPLICATION FOR LAND USE PERMITS 3 5 ° <br /> r N <br /> V, O <br /> /� N <br /> OWNER LAIc�S I �Utf� &J0 -79A;Lg C TELEPHONE (o 3S9y n <br /> O <br /> HOME ADDRESS t7 J id O m Tr <br /> Om� <br /> EMERGENCY/FIRE NUMBER f <br /> RO <br /> Z2 <br /> NAME <br /> CSS l/ /� to -3/7- <br /> E OF PERMIT(S): 3� <br /> LEGAL DESCRIPTION(see tax receipt) ur <br /> nr <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE R ADDITION 1:1 PRIVY ❑ I C/) <br /> `r <br /> Qo <br /> � � <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: rh Abi-ricffi A ri C .2y-6 CA C Gf C A LA a,—7—e/1 11- leo m ty" s <br /> (Home/ abin; Commercial Business; Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: -DALES Pt'11 S4 (o3S -7(v Z Z Er <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> y <br /> DIRECTIONS FOR PLOT PLAN DRAWING i1(AERIAL OR TOP VIEW) p m h <br /> n a C <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. Z <br /> v <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> m A <br /> m Qt-) <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 <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. SCN Zo <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO 1 <br /> BUILDINGS,ROADS, LAKE, LOT LINES. <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 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. lJ o <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN Cr <br /> g (� <br /> NEEDED. ))iCJ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 0 / 1 <br /> CONDITIONS OF PERMIT: \ J <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. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED W TER <br /> SETBA K AREA <br /> 5. � <br /> zv0r v �vv <br /> 6. >NLt[rr,-' ( P/ I GtC �P > h �C " �� CD 0 � 3a ID <br /> 0 M <br /> 7. Z y0o : <br /> . . A <br /> = �' rn <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my � �j c � A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of 'm c <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize mm <br /> M <br /> that this information I am providing will be relied upon by the County of isconsin in determining whether to is- p <br /> sue a permit. I further accept all liability which may be a result of the Cou ag pn this information I am m <br /> providing in this application. I agree to permit county officials charged ri as(m �3t,e i G u wQtnane@s or other CD <br /> authorized person to have access to the above described premises at an r sonab ttrri6r} r `(If' pection. <br /> CD <br /> a ro <br /> SIGN HERE X22 QOK�IL <br /> (si nat r of own r building contractor) (dat <br /> ZONING ADMINISTRATOR - B� nY`_ <br /> vnP� NNNNUIVIll 6a <br /> N O fn fT <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 <br />