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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator -/0 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> y O <br /> N <br /> DQOWNER cc TELEPHONE 1715-(0 1*- <br /> I s� U n��I Q <br /> HOME ADDRESS SI10 I��� � �� � ��IQ v -'v <br /> i r � <br /> EMERGENCY/FIRE NUMBER ID(eS3 ROAD NAME Haydei) LjuL <br /> l <br /> FaU,JJ 5 S IVi!S10r) 1V a <br /> LEGAL DESCRIPTION(see tax receipt)Csm I Uclurru(p pa_ i �arfe€ bt lo,u,r�,l3 <br /> n <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE Ll ADDITION PRIVY ❑ <br /> TYPE OF PERMIT(S): Q <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ ! u a <br /> Ln <br /> STRUCTURE/ADDITION USE: L'4 b'i i' ( t t p l r�o <br /> (Home/Cabin; Commercial Business, Bedroom; Deck; etc. m <br /> m <br /> BUILDING CONTRACTOR: O 1 M ZIFh C4Ica FH Tv <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/3 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 � <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> A in j <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m . <br /> T CIn Ze <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. ) �0 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m 'mom"O <br /> NORTH(N). C n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <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. 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. l 2` <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 1 2. <br /> MUST BE SIGNED AND DATED BY THE OWNER. Z ,= o <br /> IQ <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHENq 0 <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.PIiEYo <br /> ISSUANCE. /(J�� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG Ria <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECI LLY <br /> PERMITTED. �'� <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN REQU WATER <br /> SETBACK AREA.I BB � // J� , C <br /> 5. & 0,, ) Sc04 /J e re <br /> � A <br /> Lr U 'hj[p' <br /> 6. se�bA�l� w��Ce c� / Fj� 3 n F a- mM <br /> n r�Di< °' � <br /> mcNr" o � 3 <br /> �. ON1NC��NTy <br /> Z : o -i <br /> o =MM <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 3 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 0 e <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m m <br /> that this information I am providing will be relied upon by the County of Bul, goh$in in determining whether to is- <br /> sue a permit. I further accept all liability which may be a result o rt in on this information I am <br /> providing in this application. I agree to permit county offP i n jYh ,rr negls or other 1 ; m <br /> authorized person to have ss to the abov descri ed eas u e eGtion. m <br /> SIGN HERE r/ <br /> Lit er or bu Iding actor) A, - te)ZONING ADMINISTRATOR .� �� <br /> L_. ZO w fn v+v+v+v+ <br /> ZONING '/ NNNNNUI (T <br /> 37 �9 TOWNSHIP PERMITS MAY BE REQUIRED I� 0 0 0 0 0 0 0 <br /> 0000000 <br />