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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 /> UT <br /> UT 0 <br /> Sij <br /> 01MJER /y C.�►O�r13 I , ��CI ��i{SOt� TELEPHONE SUZ 1 Lit <br /> MAILING ADDRESS POork S t rG �6�.v+', r�l/I II�, (may gozo f <br /> PROPERTY ADDRESS �y 9 3 S , v) et r,),;., Poo-L ( ID= 0z0 N31'1-ab i 0 1 <br /> T V 1J. Lot 19 C--SM %09 181 <br /> LEGAL DESCRIPTION(see tax receipt) 5 6C t O►t yj I �aip /0/ "� b ( i pV Lots 5-8(j <br /> m <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION Cl) <br /> TYPE OF PERMIT(S): ❑ c ' <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION a <br /> STRUCTURE/ADDITIONUSE: Zy �.Gj <br /> S A 11 i o <br /> A ' (Home/Cabin;Commercial Business;Bedroom;De eck tc.) <br /> 1 <br /> BUILDING CONTRACTOR: % �A - N Ol y eiy i �Gr C v L.`I t• <br /> 12 <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 /> M m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> � n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. A <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 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. ( o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO O <br /> BUILDINGS, ROADS, LAKE, LOT LINES. n <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. ( N yoJ <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. 5. f <br /> o D <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z ► ' <br /> CONDITIONS OF PERMIT: o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT V� <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 /> 50 �1� to <br /> nl ,{N„/AGN' r vw` yy � Com <br /> 6. �� f/�s�nC. <br /> � �SS/.c.r-� `, ' �'/ 2 3 n COD � a m � <br /> Z ym0 <br /> I declare that this application (including any(Acompanying schedule) has been examined by me and to the best of my i C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of o') n : v, <br /> all information contained in this application(including any accompan ' �tedul@►- r"Tr- tare that I recognize ' m o m <br /> that this information I am providing will be relied upon by the Cn� u fi �iFiining whether to is- <br /> L7: <br /> sue a permit. I further accept all liability which may be a result t 4f �n a (I�is Information I am O <br /> providing in this application. I agree to permit county official d rth a ministering cou ordinances or other <br /> authorized person to have access to the above described premi at any reasonable time for the ose of inspection. m <br /> o : <br /> r <br /> SIGN HERE 1 <br /> /Z 03 `^ <br /> 7gnure of owner or b ng contractor) BURNETT COU (date) n <br /> d <br /> ZONING ADMINISTRATOR ING <br /> w <br /> cn <br /> Ln <br /> TOWNSHIP PERMITS MAY BE REQUIRED � <br /> rncu/cd +v 1�l�ls� q-/7-03 <br />