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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 /> N <br /> C <br /> OWNER j 'q t,� / �� lJ TELEPHONE <br /> m � <br /> HOME ADDRESS % 7 �// �y S5/� <br /> / J J/��4Z4)ac.K ( '/LT fR7T�� � 1�nLLG /YI r O <br /> Gn / o <br /> EMERGENCY/FIRE NUMBER ��S / ROAD NAME �(�DUti()✓cn. 2.9 ---� <br /> LEGAL DESCRIPTION(see tax receipt) <br /> ^(of7 Cc� oi ? 77diV 1 (t/ co <br /> DWELLING/BUILDING DZ GARAGE/ACCESSORY STRUCTURE Y ADDITION ❑ PRIVY ❑ o fn O <br /> TYPE OF PERMIT(S): -C, <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ Q. <br /> STRUCTURE/ADDITION USE: lJ 0 <br /> f / (Home/Cabin; Commercial Business; edroom; Deck;etc.) <br /> /y V <br /> BUILDING CONTRACTOR: 6,L7_A ,-+.✓ (�1..OS _it/ 'C e d <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 !i <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> M N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O aIn <br /> V/ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 a - 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 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <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 Cy <br /> BUILDINGS, ROADS,LAKE, LOT LINES. `G <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. Cj N O <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 <br /> W <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN Q} <br /> NEEDED. T <br /> I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Zo <br /> CONDITIONS OF PERMIT: ( <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. U ry <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. �J <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. " /0'S C7 L/ — 0,/� LO! o-F '3(y <br /> 6. roadsid,� lc II'n� moo( -Is ' 4-om 0< H. u�. rn. o-F 43Ke� � 3 a COD X <br /> D o <br /> V N C y n <br /> 7. OZ <br /> `G <br /> _ cn A <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my � c' ' c <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detai ..and accuracy of m m <br /> all information contained in this application(including any accompanyin � <br /> Tejtjar�_ t I recognizethat this information I am providing will be retied upon by the County oT� W' �ortsi lI hether tois- <br /> sue a permit. I further accept all liability which may be a result of the rdei I § tlfo mation I am <br /> providing In this application. I agree to permit count officials charge with administering county ord na ces or other ° <br /> P 9 � PP� 9 P Y � 9 IY <br /> authorized person to have access to the above described premises at ap reaso ti a or urpo cy�f inspection. <br /> m : <br /> SIGN HERECXU'�4 <br /> (sl ,n-a u—r oof-owner or building contractor) _ ^� (date) .XJ <br /> ZONING ADMINISTRATOR ZONING <br /> jU <br /> I <br /> TOWNSHIP PERMITS MAY BE REQUIRED (�f <br />