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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> CD <br /> PPLICATION FOR LAND USE PER ITS 3. <br /> (nC % R4Wj-i!? aLl <br /> OWNER F—,@d Q Pro use TELEPHONE <br /> HOME ADDR5 ESS v `h <br /> I �� r/Ikid ,ot�an�r w 15�/��/ 0 <br /> EMERGENCY/FIRE NUMBERr� K� s (� j ✓� jiQ ROAD NAME HairiS <br /> I <br /> LEGAL DESCRIPTION(see tax receipt) S('--c ;I T6L)n /� l� h' /q L,12 CS/n ��I� ! d)L <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STVUCTURE ❑ ADDITION © PRIVY ❑ O in <br /> TYPE OF PERMIT(S): n <br /> FILLING/GRADING CAMPING UNIT ❑ SUBDIVISION ❑ <. <br /> STRUCTURE/ADDITION USE: HmeN <br /> iWf tl <br /> J^� `(,Home/Cabin Commercial Business; Bedroom; Deck;etc.) U <br /> BUILDING CONTRACTOR: f J C!Y) �jJ►,r)tJfrrl�'" ' 6' <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR In B <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> � c d <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 0 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C gJ n <br /> NORTH 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 b Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. U 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. IV <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS ? Co <br /> MUST BE SIGNED AND DATED BY THE OWNER. o 0 t <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN J S <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 0 i <br /> CONDITIONS OF PERMIT: rQ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT nI <br /> ISSUANCE. 0 WJ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. l" <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY coo <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. xvCt��DODaov <br /> . o' � r' b° a <br /> 6. m <br /> OLD. � n w w o 5 3 <br /> � mCu' <br /> Z : HMW 2 : 0 � <br /> 7. <br /> o '< : <br /> m: [ m <br /> I declare that this application (including any accompanying a b a i nd to the best of my �„„ Lj C <br /> knowledge and belief it is true,correct and complete. I ackn I res ��Ie Kort tail and accuracy of b: oall information contained in this application(including any ac panymg sc>}�ua an u e d tare that I recognize � m <br /> that this information I am providing will be relied upon by the my of Burne Wisconsin in d e mining whether to is- <br /> sue a permit. I further accept all liabilitKwlY a be a res I f the C yrrelying this information I am 1 m <br /> providing in this applicatio wee to permit coun ici I hargews administering co ordinances or other m ' <br /> authorized person to h acc the above 1 e p m s s at any reasonable time for It urpose of inspectio n <br /> m <br /> 'iS.E 1 m <br /> SIGN HERE � � <br /> ZONING <br /> r of wnero Ing contractor) (date) <br /> ZONING ADMINISTRATOR <br /> rte. Y] N N fn N0100 <br /> '0000000 <br /> TOWNSHIP PERMITS MAY BE REQUIRED ' <br /> 0000000 <br />