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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v 0 (\ z <br /> APPLICATION FOR LAND USE PERMITS 3 0- <br /> ^' <br /> n o <br /> r <br /> n/� <br /> OWNER � 01II14enSeY) TELEPHONE -715 (35- 7$';qo <br /> n I o 7�.r <br /> HOMEADDRESS Qrj$� � Jq �,,aeki'j4,er, w1 54 $9 3 <br /> r� n _t r � <br /> EMERGENCY/FIRE NUMBER o05tn ROAD NAME `.O 2d A o <br /> LEGAL DESCRIPTION(see tax receipt) S Vr 5�..) N W L4 ifiG L'H S 01P V it X' C <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ O <br /> TYPE OF PERMIT(S): ' a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITION USE: "q tp XJ A <br /> (Home/ bin; Commercial Busines ; Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR � B � <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> -A y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 o C <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NBm)AND INDICATE m n <br /> NORTH(N). W 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 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. \. Q <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. Ov N 4 , <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS 2 "v <br /> MUST BE SIGNED AND DATED BY THE OWNER. --I CK <br /> o 9 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHENq 0 <br /> NEEDED. 2 Qom' <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 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 <br /> SETBACK AREA. <br /> 5. <br /> zvc>d onDo a <br /> rn <br /> 6. (DC=10009' 3 <br /> N O 0 <br /> 7. o H �� M <br /> ;a <br /> 0) ; <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my r7 c C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application(including any accompa chedule)and I further declare that I recognize � ` CDm <br /> that this information I am providing will be relied upon by the C ft Wisconsin in determining whether to is- O <br /> sue a permit. I further accept all liability which may be a res he urnett relying on this information I am m <br /> providing in this application. I agree to permit county offici harged istering county ordinances or other (D <br /> authorized person to have access to the above described pre es at gny re a for the purpose of inspection. -njm <br /> SIGN HERE / ` { ?/ /V-L) <br /> E <br /> (signature o o er or building contrac (date) <br /> ZONING ADMINISTRATOR <br /> /+ C- i P o ,n Ln 0 0 <br /> TOWNSHIP PERMITS MAY BE REQk ill <br /> 0000000 <br />