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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator "� Gi z <br /> APPLICATION FOR LAND USE PERMITS <br /> CID ° . <br /> r <br /> N O» <br /> � N <br /> C <br /> d <br /> OWNER TELEPHONE <br /> HOME ADDRESS `D v' <br /> EMERGENCY/FIRE NUMBER 8� ROAD NAME O <br /> 1 <br /> S/(� Trfo /7�u LO,3 eft/ <br /> LEGAL DESCRIPTION(see tax receipt),ok© 5 oL /A 5(0N4) ( m <br /> DWELLING/BUILDING El GARAG /ACCESSORY STRUCTURE X ADDITION ❑ PRIVY y o <br /> TYPE OF PERMIT(S): C � <br /> Cr <br /> FILLING/GRADING 0 CAMPING UNIT ❑ SUBDIVISION ❑ ?S. <br /> " <br /> STRUCTURE/ADDITION USE: Ike 30 / o' <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) y <br /> BUILDING CONTRACTOR: LSA tvEt <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8Y:X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. rt — <br /> O <br /> y <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) O m <br /> In 0. <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. Z <br /> n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> M m <br /> NORTH(N). C 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 1 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. oz <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. N Q. <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. 5• c <br /> o $ <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a S <br /> NEEDED. �Ir <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT Q <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. V/�l <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 /> 5. SETA K A,REA. <br /> `%/ � m Cir 0L0Im <br /> M M. s' <br /> m CD �o � <br /> 6. <br /> 7. Z : NCOD <br /> oy <br /> O � <br /> l Cn m <br /> I declare that this application (including any accompanyin as been examined by me and to the best of my <br /> knowledge and belief it is true,correct and complete. I It 4,sm responsible for the detail and accuracy of rr,�,, m 0Er <br /> C <br /> all information contained in this application(including ccomp le)and I further declare that I recognize W: m <br /> that this information I am providing will be relied upon he County o onsin in determining whether to is- G p <br /> sue a permit. I further accept all liability which may b result 0 he Coun o elying on this information I am m : <br /> providing in this application. I agree to permit county ¢ icials ged with a i Itig county ordinances or other m <br /> authorized person to have access to the above describetR ises at any#eAsonab #,for the purpose of inspection. T <br /> \ m <br /> SIGN HERE <br /> (signature f o er or building contrac A, v (date) <br /> ZONING ADMINISTRATOR <br /> � f»fnFnFntnee� <br /> N NUI <br /> Vt O(T O 0 <br /> Vt NEn 0 <br /> O <br /> T NSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 <br />