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'�?7 cln <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m o o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r (1 <br /> N R xj <br /> n N <br /> OWNER 1VQtr� �- (�� ^ /n—rO��,�_ TELEPHONE 60�— 7F3- <br /> 7373 p <br /> CD <br /> HOME ADDRESS ��.I Ro «��L rr ( (��„� «k Luz S y6 S0 v <br /> r � <br /> EMERGENCY/FIRE NUMBER o�7 g6 c1 ROAD NAME ko U A-N-k <br /> LEGAL DESCRIPTION(see tax receipt) _ Yo _ (� �c, 3 J m <br /> DWELLING/BUILDING ❑ GARA /ACCESSORY STRUCTURE XF ADDITION ❑ PRIVY ❑ m c <br /> TYPE OF PERMIT(S): Q ' <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: O <br /> (Home/Cabin; Cornhiercial Business; Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: COOT 94VC,&*'-` <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/z X 11 SHEET OF PAPER. ANY INCOMPLETE OR T <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. g.O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O c <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. t7 obi <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). N o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <br /> 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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. IN <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS ?, <br /> MUST BE SIGNED AND DATED BY THE OWNER. CQ0 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q ° Q i <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 1 �� <br /> ISSUANCE. I <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 n IN <br /> SETBACK AREA. <br /> 5. � This structure to be used as private residential <br /> 6 �/ garage/storage only. Not to be used for human CD � 3;rA m <br /> mCLMXr .= .'O <br /> habitation. _ m c N " o 3 <br /> =y :go Rm <br /> I declare that this application (including any accompanying schedul been examined by me and to the best of my E t7 [ C <br /> knowledge and belief it is true, correct and complete. I acknowledge thatI rr�e risible for the detail and accuracy of 0 <br /> all information contained in this application(including any acco Ing ste�9 a d I further declare that I recognize m <br /> that this information I am providing will be relied upon by the Corr �f jawnett Wisconsin to determining whether to is- C <br /> sue a permit. I further accept all liability which may be a result of th tfht{� JLfBarnett relying on this information I am <br /> providing in this application. I agree ermit county officials chat )Adh4FhIitering county ordinances or other <br /> authorized person to have access tq^e abgv6 describe ny reasonable time for the purpose of inspection. -n <br /> m <br /> CD <br /> Y12SIGN HERE / 4- 651 <br /> (sigpdure of Iding contracto (date) <br /> f <br /> ZONING ADMINISTRATOR to <br /> Ln <br /> ILI c" P uNio0 <br /> TOWN IP PERMITS MAY BE REQUIRED o 0 0 0 0 <br />