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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -U 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> CX <br /> f/1 <br /> OWNER T ACGo TELEPHONE (PS1- 451- -55491 v <br /> HOME ADDRESS14-10 ?h c>Yn oL S L k% Ea-2A .to / m V� ss l a a �Y <br /> +� r m <br /> o <br /> EMERGENCY/FIRE NUMBER ad ROAD NAME �Iihy%s0h Ad. � <br /> aol a 003; s33/SS0 01-3c-IS-35-0 0A'100 <br /> LEGAL DESCRIPTION(see tax receipt) 536/T391415*0 Rcres 4.2io LGt 3 csm vd P ISS <br /> .TA/ Gov Lot S <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE Ibl ADDITION CK PRIVY ❑ Cn <br /> TYPE OF PERMIT(S): v <br /> FILLING/GRADING ❑ CAMPING UNIT ElSUBDIVISION ElCLS. <br /> S. <br /> STRUCTURE/ADDITION USE: C cL6 i r <br /> (Home/Cabin; Commercial Business; Bedroom; Deck, etc.) m <br /> BUILDING CONTRACTOR: Se- If 5i UJ <br /> v <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 m 'o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m O <br /> NORTH(N). y o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m3 <br /> v <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. P <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. 1 IV <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. I ' <br /> 0 <br /> O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHENCr ° p <br /> NEEDED. 0 yQJ✓'' <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o Uj <br /> CONDITIONS OF PERMIT: ( (1 <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. d <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY J <br /> PERMITTED. ry <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER p`�J <br /> SETBACK A5. CREA. �^ ' � \ , `O I 'fes (= �/ <br /> 6 h y- 'Phis structure to be used as private residential 3 a CD Rr Q W CD z <br /> r garage/storage only. Not to be used for human 1 : " y o N = 3 <br /> 7. habitation. 9 H <br /> Rn <br /> I declare that this application (including any accompanying sd a as men examined by me and to the best of my E 0 <br /> knowledge and belief it is true,correct and complete. I ack le I t"r,r ponsible for the detail and accuracy of a B <br /> all information contained in this application(including any. ompany ERE I further declare that I recognize � ? � ; m <br /> that this information I am providing will be relied upon by Coun1��YY of Bur 8rn in determining whether to is- ti [ <br /> sue a permit. I further accept all liability which may be a ult of tifA unty of -"Ing on this information I am m E <br /> providing in this application. I agree to permit county off' Is chargedAitp adminis n to ordinances or other m <br /> authorized person to have access to the above described p at any reebs a time 'r the purpose of inspection. m <br /> m : <br /> /z/1 <br /> SIGN HERE Czb <br /> (sign tur of owner or building c tr ctor) — date) <br /> ZONING ADMINISTRATOR /JA <br /> 46 <br /> �irn En Fn rn v+w CA <br /> 7Z,1 N VINNfT (J1 <br /> (li O (P ut O O <br /> OWNSHIP PERMITS MAY BE REQUIRED <br /> 0000000 <br />