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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 = <br /> r <br /> m o <br /> m <br /> c <br /> OWNERLOCCyw t . OrnL1 ' oLCSDPHONE � ISp� � - -I �qg p <br /> m <br /> ^c; LI L <br /> HOME ADDRESS 7 <br /> a d 03 �G25S CLk � �a1� h ru WL O <br /> r m <br /> EMERGENCY/FIRE NUMBER Ag yt)3 ROAD NAME �li�ST LASS bcke <br /> I <br /> LEGAL DESCRIPTION(see tax receipt) PIN, L q�, ' � O <br /> , 1 cL�� rn <br /> �,�� C) <br /> CD <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ 1 c 0 <br /> TYPE OF PERMIT(S): v <br /> Cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin, ommercial Business; Bedroom; Deck; etc.) rn <br /> BUILDING CONTRACTOR: r r'tc -�1O ry <br /> -- 3 <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. T <br /> O <br /> zy O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> -n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 6 m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <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 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 /> I <br /> BUILDINGS, ROADS, LAKE,LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. I li <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. o 0 <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. 2 <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 �1 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 6. m 3 n m F ° m <br /> -o D c <br /> 5„ 00 <br /> 7. o j' <br /> _ C, : : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G7 O <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of o <br /> all information contained in this application(including an accompanyingschedule and 1 further declare that I reco nize <br /> PP C 9 Y ) g ° m m <br /> that this information I am providing will be relied upon by the County of Bu_ onsin in determining whether to is- O <br /> sue a permit. I further accept all liability which may be a result of the Co u mtl <br /> tl}�-jIhformation I amproviding in this application. I agree to permit count officials charge i 'sjm InaryGes or other /authorized person to hav access to a CP <br /> ove desc ed emises at aht easona a of inspection. -n [ <br /> CD <br /> m <br /> SEPSIGN HERE <br /> (signature of owner or building contractor) - (d to <br /> ZONING ADMINISTRATOR i/lI Fla 'BURNETT COUN <br /> ING I $-3D-ffcc. <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />