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UW& <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 3 0 0 <br /> APPLICATION FOR LAND USE PERMITS N <br /> 6S�- c/qv- X9`3 a <br /> TELEPHONE O <br /> OWNER S, AA#11116S O <br /> f <br /> S140"OlNis' MAJ, $06/Z-b <br /> HOME ADDRESS j9D NnLl1� �` --Ii <br /> o <br /> EM <br /> ERGENCY/FIRE NUMBER 2$( lU FI', ROAD NAME iJ <br /> Wt 1 G,S•»1. V. B P, Isl-.252 A4" oG moJ.t-ot3�sec.23 I <br /> o2rrl E r ro ,vor ,ur <br /> Nr <br /> LEGAL DESCRIPTION(see tax receipt) �� o <br /> PRIVY ❑ c <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRIn <br /> UCTURE ® ADDITION ❑ n <br /> TYPE OF PERMIT(S): ` <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ o <br /> STRUCTURE/ADDITION USE: oil Cn <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) m <br /> BUILDING CONTRACTOR: v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n y. <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O a C> <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n a Z . <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C <br /> 7SA <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE fn <br /> 0-5 <br /> NORTH(N). S)TO ALL LOT LINES, <br /> BUILDING(S)TO <br /> 3. SHOW DIMENSIONS IN FEET OF FOLLOWING: <br /> (A)BUILDING( <br /> TO THE ORDINARY HIGH WATERMARK(OHWM)OF m Z <br /> CENTERLINE OF ROAD,(C)BUILDING(S) <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <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 /> SEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 5. INDICATE IF A WALKOUT BACHITECT,ENGINEER, ? <br /> . IF SEPARATE FLANS ARE SUBMITTED BY AN ARp, 0 9J� <br /> 5R,BUILDER,CONTRACTOR,ETC.,THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> W 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o 1 <br /> NEEDED. Z Imo' <br /> o —► <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 1 <br /> CONDITIONS OF PERMIT: a <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. V\ <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. o� r n 0 > f m <br /> 5. COD N m n,T 3 <br /> 0 5 <br /> a N o <br /> s. o T� ro <br /> N <br /> 7. 10r <br /> I declare that this application (including any accompanying schedule) has been examined nsible o me and r the it and the best accuracy o <br /> m o_ : <br /> m <br /> knowledge and belief it is true,correct and complete. I acknowledge that <br /> ' g schedule)and I further declare that I recognize c m <br /> all information contained in this application(including any accompany <br /> Wn <br /> that this information I am providing will be relied upon by the County B rnett isconsin in determining whether to is- <br /> that <br /> I am v 1l <br /> sue a permit. I further accept all liability which may be a result of th i i ces or other m <br /> providing in this application. I agree to permit county officials char r inspection. -nauthorized person to have access to the above described premises at m <br /> CD a <br /> Am 3 <br /> 31 - I <br /> SIGN HERE <br /> (signature of owner or bull ing contractor) �(J <br /> NETT . <br /> ZONING ADMINISTRATO ZONING <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />