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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator' � a G) o <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> y O <br /> H <br /> OWNER Grc�,oVy t)ot\ ,.le,'Ier TELEPHONE -7/.S -,'17- -'10&;2- n <br /> 0 v 1 <br /> HOME ADDRESS VO(VIaki L-) I <br /> m <br /> EMERGENCY/FIRE NUMBER ,� 3 7 ROAD NAME <br /> II <br /> ( P) l -T �, �m ✓, �l P. a .n 6,L. C� 1B-3-r� y <br /> LEGAL DESCRIPTION see tax receipt) <br /> d o <br /> DWELLING/BUILDING ® GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ rn <br /> TYPE OF PERMIT(S): Q <br /> FILLING/GRADING //❑ CAMPING UNIT ❑ SUBDIVISION <br /> )7 ❑ 5 <br /> STRUCTURE/ADDITION USE: O "tet � 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) Cl) <br /> m <br /> BUILDING CONTRACTOR: 'm✓41CD <br /> �, <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. T 3 M <br /> 11 H 3c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> CL <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n a <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. 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. Uri <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. o c <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN 0 ° Ot0 <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 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 S <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SV ' CK ARE�A.,^L <br /> 5. V Il / Lp� �P u <br /> A -0 = O C O m <br /> M <br /> nt �. ma m <br /> rD C N fA O ic <br /> o .Z1 <br /> ct <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of d '• m 0Er <br /> c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m <br /> that this information I am providing will be relied upon b the Count oMlMtriicburrty� <br /> p g p y y determining whether to is- : 6 : : : p <br /> sue a permit. I further accept all liability which may be a result of then I on this information I amproviding in this application. I agree to permit county officials charordinances or other m E <br /> authorized person to have access to the ove described premises at any reasonable time for the pu ose of inspection. m <br /> OCT 3 0CD <br /> SIGN HEREy <br /> (signature o mer or building co ctor) (date) <br /> BURNETT COUNTY <br /> ZONING ADMINISTRATOR • • • • . <br /> �IA46�40� <br /> N NCn N N(TM <br /> VI ut O PN OO <br /> TO SHIP PERMITS MAY BE REQUIRED ° 0 0 0 0 0 0 <br />