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L� <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator _ o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> N � <br /> L� r / / t <br /> OWNER TELEPHONE LOJ! — 155 <br /> ��/ <br /> HOME ADDRESS 3�5� ?d/r� ytjL LC _y4rti' S&"i'eA, AV SSG j� <br /> r <br /> 0 <br /> EMERGENCY/FIRE NUMBERq2tnL."_. ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) 5aT11RESjjAq 401 17 CD <br /> 01 <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIW ❑ N <br /> o <br /> TYPE OF PERMIT(S): v <br /> FILLING/GRAD G �AMPING UNIT ❑ SUBDIVISION ❑ a <br /> 1 � <br /> H <br /> STRUCTURE/ADDITION USE: j <br /> / q J (Homei'Ca in; om rcial Business; Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: 6�1�Aod lkgz &'*fes [v ^ <br /> CCDm <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 61( l�� t\t j-.�I-c j ��� $ Y � p <br /> ja <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n .L1� r O n <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. in Zir a <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). N n1• <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m � <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <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. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS UJ <br /> MUST BE SIGNED AND DATED BY THE OWNER. 1 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHENb q ° 0 <br /> NEEDED. 2. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o \ <br /> CONDITIONS OF PERMIT: CD <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ` <br /> ISSUANCE. t� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 1. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY T <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> X -00r ODnO � <br /> ru �• m m m <br /> 0 <br /> coo <br /> 7. N <br /> 0 il ` ' � .� <br /> o : <br /> _ m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c p <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of o c <br /> all information contained in this application(including any accompanying sch d I further declare that I recognize m m 7a <br /> that this information I am providing will be relied upon b the County of Burne i ining whether to is- J p <br /> sue a permit. I furtRaifi <br /> ccept all liability whi ma/un <br /> suit of the County e I i on I am (/` m <br /> providing in this ap n. I agree to per t coicials charged with a inl e o a or ther k mauthorized person tv ccess to th bove es premises at any rea ble time for the r e ion. -n E E <br /> CD : <br /> CD : <br /> MAR <br /> SIGN HERE 'I <br /> ( natu of own ilding contracto Bvp'•E (date) <br /> ZONING ADMINISTRATOR � �T rll/V n COU <br /> V1 40 40 44 6S 4a <br /> ��,///���N N0 N NU1 fT <br /> TOWNSHIP PERMITS MAY BE REQUIRED +_r I0 0 0 0 0 0 0 <br /> 00000000 <br /> , 37� 61 <br />