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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> N O» <br /> N <br /> C <br /> OWNER Mori q'y 15L _�SQ TELEPHONEIN <br /> �Q <br /> HOME ADDRESS R—I 7 _ IS��� l]� h � 6 6-Q 3 7 <br /> 1R `1 r - 1— <br /> EMERGENCY/FIRE <br /> EMERGENCY/FIRE NUMBER ROAD NAME-HOLLIJen La K a b f <br /> S34/T4l JRItoW Acra.s 1 . 3 D L&T2 o,S.KV <br /> LEGAL DESCRIPTION (see tax ip) 2-4 116- 34-0 (03300 (In L-• Yz. W& Gay La � co <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ N <br /> TYPE OF PERMIT(S): or <br /> FILLING/GRADING CAMPING UNIT ® SUBDIVIS N ❑ <br /> STRUCTURE/ADDITION USE: ° ' <br /> (Home/Cabin; Commercial Business; edroom; Deck;etc.) y <br /> m <br /> BUILDING CONTRACTOR: Er <br /> CDv <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O c <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). (a _ 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 3 <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 9 <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. Q <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N V,) <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. to o ) <br /> o fh <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN <br /> NEEDED. U) <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. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY yj <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. C Y Y? <br /> 7. o N =M <br /> = U' m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my L7 c C <br /> knowledge and belief it is true,correct and complete. I acknowledge am responsible for the detail and accuracy of 0 LT <br /> all information contained in this application(including any ace mpa i le)and I further declare that I recognize m (D . : . <br /> that this information I am providing will be relied upon by the C r e ' nsin in determining whether to is- O <br /> sue a permit. I further accept all liability which may be a result a Co fh 1 Ing on this information I am m <br /> providing in this ication. I agree to permit county official arged with e ty ordinances or other m <br /> authorized pens n to ave access to the abo cribed premi at any asonable i0 'purpose of inspection. m <br /> SIGN HERE v. LeU V t- 00 <br /> (signs of owner building co c r) �C (date) <br /> ZONING ADMINISTRATOR <br /> y N N(T01 <br /> [T(EO NT 0 a <br /> VI Ut 0 O <br /> OWNSHIP PERMITS MAY BE REQUIRED 233 <br /> 0000000 <br />