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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 . <br /> r <br /> y O <br /> H <br /> OWNER , (�'� "�I'jt t" 40G[TELEPHONE (-7i'5>9330 — :5r4-k4 <br /> m � 1 <br /> MAILINGADDRESS 33 3 7 7v <br /> Sc �(� r <br /> PROPERTYADDRESS pr V I 7 � /�t`C O 'W�' / C�� 5 f r/ '3 0 <br /> O <br /> LEGAL DESCRIPTION(see tax receipt) ��..L ��CJ/a/ C�yf-� ✓, <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ ( (n ° <br /> TYPE OF PERMIT(S): v ' <br /> FILLINGIGRADING 1:1 CAMPING UNIT El SUBDIVISION <br /> RA ❑ <br /> STRUCTURElADDITIONUSE: Yt�L/Ft��KYZdISTNL� STg/, _ ,4DOlN& 46Jp11 o <br /> (Home/Cabin; Commercial Business; <br /> /Bedroom; Deck;etc.) IN9/ rn <br /> BUILDING CONTRACTOR: Zf&6y&)W A`yrm^)/N!s GJI46 <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> O _ <br /> A m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O M <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n 30 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <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 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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADE �R FILLED. N XJ <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, Cq T,1L TC.,THE PLANS 1 <br /> MUST BE SIGNED AND DATED BY THE OWNER. J /� o ^� <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFr TION MAY E� — S <br /> NEEDED. ( AUG <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. ���/// A 20 <br /> I YJ <br /> CONDITIONS OF PERMIT: BURN o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ZO C�VIV7 y <br /> ISSUANCE. NTNG r <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 /> m uOim0MCL:E M <br /> 6. 3 'a m Ox m <br /> 7. Z N ry O O <br /> O j`z <br /> rin <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G7 co <br /> c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of w 0 e, <br /> all information contained in this application(includingany acco anying schedule)and I further declare that I recognize m o m <br /> that this information I am providing will be relied upon by the eft Wisconsin in determining whether to is- m <br /> L7 <br /> sue a permit. 1 further accept all liability which may be a resul urtett relying on this information I am m <br /> providing m this application. I agree to permit county officials char ring county ordinances or other <br /> P g PP 9 P tY g 9 tY <br /> authorized person to h e access to the above described premises at any reason a for the purpose of inspection. m ' ° o <br /> ID <br /> CD <br /> SIGN HERE 2O �� Z-- <br /> n : <br /> ( n reof ow or building co _ (date) <br /> ZONING ADZNSTRATOR �` <br /> . ,_..... .: �AJ, '6969 v � 169 <br /> t[ NJ0OB D 0T0O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />