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r <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator _V G) Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> N O X!J <br /> D V <br /> OWNER Da n D e TELEPHONE "-7 I'S' <br /> MAILING ADDRESS <br /> 52;g Si I Y` �jp r Yl q rj �� ? l 6 i ' ox :E <br /> r m <br /> /� ' <br /> PROPERTY ADDRESS nT 7 k 5S 1�IZ gn'q-p 1 0 <br /> r01 !d:�T-7 N rcabO yn e e <br /> LEGAL DESCRIPTIO (see tax receipt) AVIS/Uh Tt) Vn D� SG OTT Bu/re rT L0 �fJ <br /> Q <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ o <br /> TYPE OF PERMIT(S): c 0 <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ Cr <br /> S. <br /> STRUCTURE/ADDITIONUSE: A/'� o7Oin Y Uf LA. <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) r <br /> d <br /> BUILDING CONTRACTOR: <br /> m <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 (' <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. n 3 <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING• (AERIAL OR TOP VIEW) 0 <br /> O m <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. �1 ? <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE n v A <br /> Mm <br /> NORTH(N). C .t.1 0 <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 <br /> BUILDINGS, ROADS, LAKE, LOT LINES. q <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. F�o <br /> F <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN g <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z 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. ( I <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 /> SETBAqx AREA, <br /> 5. 0 y GU <br /> 6 7 l m 0 y D O D 0 M <br /> Z N 7. O O 2 1 <br /> TiK <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ^� - T p <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of ` v c <br /> all information contained in this application(including an �' <br /> PP ( 9 Y Banc'L fLrther declare that I recognize m ; o ;U <br /> that this information I am providing will be relied upon b n 1 1 i1ri determining whether to is- m O <br /> sue a permit. 1 further accept all liability which may be a I Ing on this information I am 00 <br /> providing in this application. I agree to permcounty icials c arge wit a m nis a county ordinances or other m <br /> authorized person to have acce to the above describe remises at an reasonable ti m f r the purpose of inspection. <br /> oCD : <br /> SIGN HERE <br /> CL <br /> s nature rorbulldingco@TT COUNTY (date) a . <br /> COUNTY <br /> ZONING ADMINISTRATOR . <br /> Q: <br /> N (T N N OO <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 <br />