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U 1 <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v 0 Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> OWNER TELEPHONE (o / 7 77- C'd 73 <br /> ^ / m <br /> HOME ADDRESS �So y � ,, a�lfh S'r. * a'mMa-' t; / -7 !� <br /> /'n//�`� G�� o m <br /> EMERGENCY/FIRE NUMBER ROAD NAME I . <br /> y -I <br /> LEGAL DESCRIPTION (see tax receipt) k'T n r( a <br /> m <br /> TYPE OF PERMIT(S): <br /> DWELLING/BUILDIN GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ElPRIVY ❑ Cl) 0 <br /> FILLING/GRRA/DINNG�❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: /7(//�'�/ �AEJ I A o_ <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) 0 <br /> m <br /> BUILDING CONTRACTOR: //C�/✓ /IIf/ � <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR CD <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n3 <br /> JrN <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 <br /> n <br /> ,n O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> f) m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(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. 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. 0 <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADE N n <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONT T,GLT A ° XJ <br /> MUST BE SIGNED AND DATED BY THE OWNER./5( o <br /> /I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICA ON MPNff DANE WHEN o o <br /> NEEDED. 1111 �t//MM ( c , I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. BURN J `• Z '1 <br /> CONDITIONS OF PERMIT: E]T r% ° <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 20N/NG UNN d <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. �vv iii <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 /> SEK AREA <br /> 5. <br /> A W D C D 0 <br /> 0 CD <br /> 6. m � 3 'am0, - (D <br /> D C <br /> 7. <br /> o T'� `gym <br /> — Cn A <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G) L 0 <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of o <br /> all information contained in this application(including an accompanyingschedule and I further declare that I recognize <br /> PP ( 9 Y ) m mm <br /> that this information I am providing will be relied upon by the County of Burnett Wiscons' t i i whether to is- �' <br /> � g C <br /> sue a permit. I further accept all liability which may be a result of the County of Burnet I I I I rrti� I <br /> providing in this application. I agree to permit county officials charged with administ i I e o <br /> authorized person to have access to the above described premises at any reasonable ti or s r n e ID <br /> SIGN HERE / Ows 20 <br /> ( Igna o\vner or building contracto (date) <br /> ZONING ADMINISTRATOR EiL/[l BURNETT COUNTY <br /> ZONING <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />