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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 o o <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> ir r <br /> o <br /> c <br /> ! 7,3/Fd;, n <br /> OWNER eh� �_ � TELEPHONE -7�5 ,6e <br /> HOME ADDRESS Q 7�� j L (! fl n Q,� -t- � j�J �" <br /> EMERGENCY/FIRE NUMBERG 74a ROAD NAME 0 <br /> Eltaw IG�� <br /> 11cj StV 6 t� <br /> LEGAL DESCRIPTION (see tax receipt) Q a� t�_ /� y <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE [Z ADDITION ❑ PRIVY ❑ 6 o <br /> TYPE OF PERMIT(S): rn 0 <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> S. <br /> STRUCTURE/ADDITION USE: �� <br /> _ In✓uge' L ✓X S�o o T. <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) y <br /> BUILDING CONTRACTOR: `SQ-4 H'o fn <br /> firv <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/a X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING, (AERIAL OR TOP VIEW) O � <br /> o�o <br /> n o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m 1 <br /> NORTH(N). C O <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 <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. Z <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO �l <br /> BUILDINGS,ROADS,LAKE,LOT LINES. C r <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 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. c <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHENa I <br /> NEEDED. <br /> n <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z <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 <br /> PERMITTED. ) <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER QKZ <br /> SETBACK AREA. <br /> 5. Q <br /> � � <br /> �� <br /> 6. 3 <br /> ID I nm n•n <br /> v m w Q - <br /> CD C 0 > <br /> 7. Z yCODo of <br /> o <br /> y : : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my i7 c O <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize CX <br /> m m <br /> that this information I am providing will be relied upon by the County Min <br /> mining whether to is- <br /> sue a permit. I further accept all liability which may be a result of t44 o his information I amrovidin pp g p ty ,op gin this a lication. I a ree to ermit coun officials cha' rdinances or other m , <br /> authorized person to have access to the above described premises any reasonable time for the p ose of inspection. <br /> m ' <br /> (� MAY - 4 2W <br /> SIGN HERE <br /> (signature of owner or building ontractor) (date) <br /> ZONING ADMINISTRATOR �iURNETT COUNTY ' s s <br /> L i/n a(11 ZONING <br /> . kntnON " Ehul <br /> N NfTN W <br /> UtONUtOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />