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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 'D o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> 0 <br /> m o <br /> m <br /> OWNER � /7z�L TELEPHONE <br /> HOME ADDRESS <br /> 1�07t 09CC c/ LC/j _57!C'j.ZS o <br /> EMERGENCY/FIRE NUMBER ROAD NAME e 1 <br /> o <br /> LEGAL DESCRIPTION(see tax receipt) clee Cn <br /> 0 <br /> DWELLING/BUILDING GARAGEIACCESSORY STRUCTURE1:1 ADDITION PRIVY y M <br /> TYPE OF PERMIT(S): c <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ 2' <br /> y. <br /> STRUCTURE/ADDITION USE: CA8/!V /Tl 70 'vL—SCAe-e--y (' o' UQ <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) m <br /> BUILDING CONTRACTOR: Ev <br /> v <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> x c <br /> DNtEOTtt,"11009- : WAN YSR ANNG: (AERIAL OR TOP VIEW) 0 <br /> T O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> NORTH(N). y ` 3 <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 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. I <br /> 6. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. lJl` <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 2. <br /> MUST BE SIGNED AND DATED BY THE OWNER. c )r <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN qo <br /> NEEDED. T <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 Q <br /> PERMITTED. "fl <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> ;ov0Or; o oCD m <br /> � 3 Ix <br /> 6. » CD N p CM <br /> 7. 3 <br /> 7. o N <br /> = yi m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 11�' c i ? C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of o <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m i m <br /> that this Information I am providing will be relied upon by the County ett Wisconsin in determining whether to is- S O <br /> sue a permit. I further accept all liability which may be a result of the g I ing on this information I am ? ; <br /> providing in this application. I agree to permit county officials charg� m ni aances or other L ': m <br /> authorized person t ave access t the above described premises at, r r of inspection. -n <br /> M : <br /> SIGN HERE 4 / <br /> (si ature f ror bu i contractor) at ) <br /> ZONING ADMINISTRATOR 0 <br /> 4a 46 4a 40 49 <br /> Z0•,'� N Nu,Nn 91 J <br /> (\1 G f71 NONfJCO <br /> TOWNSHIP PERMITS MAY BE REQUIRED• o 0 0 0 0$o <br /> 00000 0 <br />