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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator -0 0 Z <br /> APPLICATION FOR LAND USE PERMITS 3° ry4 1 <br /> UT 0 'V <br /> Emma. S�e��` TELEPHONEI _ � <br /> OWNER S <br /> is- <br /> HOME ADDRESS <br /> 3059 Ctu (y �(J� L'AAlwa.41 FglA&:MA, SSO0 <br /> r � <br /> EMERGENCY/FIRE NUMBER -1 8F�Cl ROAD NAME N Ma �va '� u t RD p 1 0 <br /> LEGAL DESCRIPTION(see tax receipt) P I^ G. <br /> L I � � ` JIT39 hl k\j" Iw (� <br /> II CD <br /> DWELLING/BUILDING X GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ d U) <br /> TYPE OF PERMIT(S): c h' <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> n <br /> STRUCTURE/ADDITION USE: 14W.t/(if �I rf/ 0 <br /> Home/Cabin; Commercial Business; B oom; Deck; etc.) <br /> BUILDING CONTRACTOR: <br /> 0 <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/: m X 11 SHEET OF PAPER. ANY INCOMPLETE OR � <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> O n <br /> A C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> n o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n Wv <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <br /> 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 o <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. <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 Q <br /> MUST BE SIGNED AND DATED BY THE OWNER. 1 <br /> O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN � <br /> NEEDED. n <br /> J <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: Q <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 WATER LI <br /> 5. SSET)BAAC,KpKAREA. F <br /> CD nrDODO '9 <br /> T mdomo- fm <br /> 6. 0na <br /> < 300cD ;u <br /> 7. <br /> o ' <br /> = v : 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 m 0 m <br /> all information contained in this application(including any a nd I further declare that I recognize E ;0 <br /> CD <br /> that this information I am providing will be relied upon by th , mtrpose <br /> fining whether to is- <br /> G) : <br /> sue a permit. I further accept all liability which may be a res t t o r rhis information I am m <br /> providing in this application. I agree to permit county off_ <br /> harge wi a I riordinances or other <br /> authorized person to have access to the above described pre I s at any reasonable time for of inspection. fD <br /> y/+ JUL ID <br /> CD <br /> T <br /> SIGN HERE (i Z q �� "('� <br /> (signature of olperor building contractol3URNETT COUNTY (date) <br /> ZONING ADMINISTRATOR ZONING d �J <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />