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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator o o <br /> APPLICATION FOR LAND USE PERMITS 3. In <br /> n. r Cy <br /> N o y..J <br /> S_ / OAq/ _o� Oho/ OC •) \ 1y7-1 <br /> OWNER TELEPHONE 7/V �S 77&6/' <br /> HOME ADDRESS 7 Q E56 rO VIN •- 'eb ��AM75 g L')ye 11 /S2-1-94 v � <br /> 0 <br /> tA1 <br /> EMERGENCY/FIRE NUMBER r Q ROAD NAME C� DSc' I Q �N <br /> LEGAL DESCRIPTION(see tax receipt) 2-38 _/ -e 0a744 PC/- ,-5 Ydg(5w&FC- X C5 1),7 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ Cn a <br /> o <br /> TYPE OF PERMIT(S): � <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> N <br /> STRUCTURE/ADDITION USE: -T)G-e.K o <br /> (Home/Cabin, Commercial Business; Bedroom; Deck;etc.) U) <br /> f7/S_ 6&17- 2 64 2 <br /> BUILDING CONTRACTOR: L i3R R V /F/Cl /1 <br /> /36 C jeoss rcGry ip[9 <br /> G?-fi175/Scr?6-- W/ SVr'fo <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. O m <br /> x N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) Om <br /> n CL <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). y -� o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m C>Cj <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. d <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o c 1 <br /> o 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN 0I n <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o YJ� <br /> CONDITIONS OF PERMIT: / <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT O <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 /> ;a -0C)r OQDO 'V <br /> m • m 3d m m <br /> 6. �' � CL0'X <br /> m C y ^ o 3 <br /> 7. Z N m , <br /> o : <br /> o) M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my O L7 c ID <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 accompan I_ dule)and I further declare that I recognize ^'``� �m [ m <br /> that this information I am providing will be relied upon by the Coun �o )etermining whether to is-sue a permit. 1 further accept all liability which may be a result oft �vthis information I amproviding in this application. I agree to permit county officials chaed wit IEC�' ordinances or other m <br /> authorized person to have access to the above described premise any reasonable time for the p se of inspection. T E <br /> JUL 242�p7 do � ` <br /> SIGN HERE <br /> (signature ovgVerr building contractor) QURNE� d te) <br /> I COUNTY <br /> ZONING ADMINISTRATOR I C 40 <br /> to ro to is to w Cn <br /> N N PP <br /> VINNCn <br /> Vt VI P !-" PO O <br /> TOWNSHIP PERMITS MAY BE REQUIRED ° 0 0 0 0 0 0 <br />