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&n6&7L?P <br /> 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 /> 0 <br /> OWNER Es%.A7� O F TOA.,, J. B�eIlen <br /> TELEPHONE 773 32.7`17eu o J <br /> d � <br /> HOME ADDRESS Pw_ kk- 13 <br /> _ o <br /> EMERGENCY/FIRE NUMBER ly(sg ROAD NAME <br /> 1 <br /> LEGAL DESCRIPTION (see tax receipt) �p f r�eI-( 7-1. / <br /> n 2 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ItbJ PRIVY ❑ C <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING <br /> ❑ CAMPING UNIT ❑ SUBDIVISION ❑ �- <br /> STRUCTURE/ADDITION USE: CG4in a'vJi+an 2x�^�•^� IC11CI+en Ec.�.nC Alec+ <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) 3 cn <br /> m <br /> BUILDING CONTRACTOR: Self &obe/'i �• �eII{r1 <br /> m <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. n <br /> w C� <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 O n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 3 m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m AS <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 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. N <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. f <br /> 0 O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN = 0, <br /> NEEDED. 1 <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 <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. �j, <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER 6 <br /> SETBACK AREA. <br /> 5. <br /> t m _V 0r-r <br /> a) 0 ° a0 m <br /> 6. COD ` LL <br /> m cy N o 3 <br /> y N <br /> 7. O T� XI <br /> - � A <br /> I declare that this application (including any accompanying schedule) has be ie 61-LI of my C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I ami e u acy of o A <br /> all information contained in this application(including any accompanying sche le)and I further declare that I cbgnize ` <br /> m 0 <br /> that this information I am providing will be relied upon by the County of Burne Wisco tJ�rq whe er to is- O <br /> sue a permit. I further accept all liability which maybe a result of the County o Burne n drl t1+iS`1�form n I am <br /> providing in this application. I agree to permit county officials charged with inistering county ordinance other <br /> CD <br /> authorized person to have access to the above described premises at any reasona spection. T <br /> m <br /> ZONI G q <br /> SIGN HERE J "�'<1 r d f <br /> (signature of owner or 'ding contractor) (date) .0 <br /> ZONING ADMINISTRATOR <br /> D <br /> TOWNSHIP PERMITS MAY BE REQUIRED ' <br /> (: ) C <br /> iI <br />