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Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator v O Z <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> N � c <br /> n'�;^ C V <br /> OWNER `{ .SC�J� TELEPHONE (F7 -)/S- CL <br /> m <br /> v <br /> — °MAILINGADDRESS ) p Dh � lA� � t <br /> PROPERTYADDRESS O Z <br /> m <br /> LEGAL DESCRIPTION(see tax receipt) Oa Ks 9_ ) <br /> O ur <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION 0 <br /> TYPE OF PERMIT(S): / to 0 <br /> C <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: 1 nJ(n1G P�00/✓1 <br /> a o <br /> o' <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) y <br /> EZ aZ/ m 77 <br /> BUILDING CONTRACTOR: <br /> o <br /> 12 <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR � <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n 3 �J <br /> O (S� <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 <br /> O M <br /> -n a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. MZ <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE M o A <br /> m m <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TOm 0 <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. n , Z <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO X1 .. <br /> BUILDINGS, ROADS, LAKE,LOT LINES. 0 <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N S� <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS 0 O <br /> MUST BE SIGNED AND DATED BY THE OWNER. - 0 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. w <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z ) <br /> CONDITIONS OF PERMIT: o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT V <br /> ISSUANCE. W <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 WATER <br /> SETBACK AREA.5. , / C L^ W <br /> 6. �( V�TI71i'0, �1 Sc�i1ri /1� /1i1- 1. <br /> M C-g >0 a F m <br /> / N C(^ y 0 0 ic <br /> 7. Z N N O (O <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my – A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of d 0 c <br /> all Information contained in this application(including an accom an I a <br /> pp ( 9 Y P f Clare that I recognize (o o : m <br /> that this information 1 am providing will be relied upon by the Coun nett n n reining whether to is- 0 <br /> sue a permit. I further accept all liability which may be a result ofd O <br /> providing Y his information I am m : <br /> p g in this application. I agree to permit county officials ch rged with administering coun ordinances or other <br /> authorized person to have access to t4 above described premises Ot any rWapable time for the rpose of inspection. m N <br /> ^ \J -n = <br /> SIGN HERE _ <br /> (signatu- r�`f owner r building contractor) COUNTY (date) C �' <br /> ZONING ADMINISTRATOR ZONING G <br /> fA fA fA fA�N <br /> N <br /> cn 0 <br /> O• N N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED (n (n o 0 <br />