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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of ZoningAdministrator <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> — r <br /> N <br /> C _ <br /> N <br /> OWNER V e r p�RIV IL e / TELEPHONE �j 5_C4& ljl <br /> Q zb 2 <br /> HOME ADDRESS ',Z �� O 11 e �.� �R l� C Ht1�Scs( Q �I �Lc, v <br /> r m <br /> EMERGENCY/FIRE NUMBER \Q 8 ROAD NAME % <br /> AjsI <br /> LEGAL DESCRIPTION(see tax receipt) ^ 1 <br /> ACMm <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDIT ❑ ❑ `1 yo <br /> TYPE OF PERMIT(S): h <br /> ION PRIVY G <br /> FILLING/GRAD, G ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: 0 <br /> (Home/Cabin,Commercial Business; Bedroom; Deck; etc.) m <br /> BUILDING CONTRACTOR: t%me r 1 SU \ �• \� C, a �h,rk >�� <br /> v <br /> PLOT PLAN MUST BE PROVIDED LEAST AN 8'/:X 11 SHEET OF PAPE INCOIIQpj ETE O <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED.NED. ASl//Jr.Qv -16v, r O 3. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O <br /> CD <br /> Pft L�rt�� e NOS m a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m .? <br /> NORTH(N). C <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. Z <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. Q <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS N0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> fo <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN 4 <br /> NEEDED. M <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT �}1 <br /> ISSUANCE. 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. i <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 /> X 'oCDr l7 O '9 <br /> 6. 0 3 m <br /> v mCinapS3 <br /> 7. Z : @m� <br /> m <br /> I declare that this application (including any accompanyin has been examined by me and to the best of my :: O <br /> knowledge and belief it is true, correct and complete. I ac e m responsible for the detail and accuracy of m C <br /> all information contained in this application(including n ac c I and I further declare that I recognize 4 (Dm ;a <br /> that this information I am providing will be relied uponthe Coun a sin in determining whether to is- M <br /> sue a permit. I further accept all liability which may b result the Cou u tt relying on this information I am <br /> providing pp g P m <br /> p gin this application. I agree to permit coun fficial �r d with ad ng county ordinances or other <br /> authorized person to have ac e"to the above describe remises at�t r nable ti for the purpose of inspection. <br /> A m ' <br /> SIGN HERE <br /> (sl aturk of owr4r ilding contra �A,^ I- _ (date) <br /> ZONING ADMINISTRATOR 'VV l' <br /> tow to W to!n <br /> N N (Ji N N(T0 <br /> u N O N M O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED �� 0 0 0 0 0 0 0 <br />