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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 /> y O <br /> / �I��// // <br /> OWNER �Q s {1 �n�y(�(�/�'GL TELEPHONE ��j_ yj�s-788 o a <br /> /J ,�� �, D <br /> HOME ADDRESS <br /> EMERGENCY/FIRE NUMBER 3 G Q ROAD NAME SfcZ-�Q Rq�, 3S *1 V 1 <br /> LEGAL DESCRIPTION see tax receipt) � <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ 1 O J <br /> TYPE OF PERMIT(S): Q <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SU DIVIS ON ❑ `- n' <br /> p J T. ti <br /> STRUCTURE/ADDITION USE: CCeSS01'p ra D/QB• <br /> C , (Home/Cabin; ercial Eusinask Bedr om, ;etc.) m <br /> BUILDING CONTRACTOR: <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81AX 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> O <br /> y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) OT n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m ^' <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATECD <br /> C <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m Q f 3 <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. �I <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 2 <br /> MUST BE SIGNED AND DATED BY THE OWNER. O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN ° <br /> NEEDED. <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 <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 I <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING ALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBAC AREA. <br /> 6' .r r > CI > 0M <br /> 4' /K �.J�- J • 1 11, c0i o f m <br /> CL 6. , m X ° 3 <br /> O N N O y O 1 <br /> 7. 0 : T� m <br /> = (p i <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Q C <br /> knowledge and belief it is true, correct and complete. I acknowledge t t I am responsible for the detail and accuracy of n a <br /> all information contained in this application mcludin an accompany edule and I further declare that I reco nize 1 1 ; <br /> PP ( 9 Y p Y ) 9 W ? m m p <br /> that this information I am providing will be relied upon by the Count isconsin in determining whether to is- w C) <br /> sue a permit. I further accept all liability which may be a result oft lit relying on this information I am d <br /> providing in this application. I agree to permit county officials c d w i county ordinances or other <br /> authorized person to have access to the above described premis any reaso a purpose of inspection. -n m <br /> m <br /> CD <br /> SIGN HERE <br /> (signatur o w A�_ i/�jy,/ ate) �} 3j <br /> ZONING ADMINISTRATOR <br /> NiAk LNC . . <br /> OWNSHIP PERMITS MAY BE REQUIRED <br />