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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator M c0,�o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> _ r <br /> CD <br /> OWNER Wham IhQYYt mvtaCf-OL TELEPHONE 71 S-0(0b—�Y0 / o •' v <br /> Er <br /> HOME ADDRESS <br /> 0 <br /> EMERGENCY/FIRE NUMBER 939 ROAD NAMEeC0- K� <br /> pcl GLS <br /> LEGAL DESCRIPTION(see tax receipt) / N <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ® ADDITION ❑ PRIVY ❑ I C :0, <br /> TYPE OF PERMIT(S): Cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ 0 a <br /> nn N <br /> STRUCTURE/ADDITION USE: I�QrQ! ot✓ 3& ;6 !5c2- <br /> (Home/Cabin; <br /> & x5a-(Home/Cabin; Commercial Business; Bedroom; Deck;etc.) C <br /> BUILDING CONTRACTOR: ':A/)ry)a -s O I)e-r g f <br /> v <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. A m J <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n o. Q <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. v z <br /> M <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE M n <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. P <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO O <br /> BUILDINGS,ROADS,LAKE,LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. o <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS 0 c 1 <br /> MUST BE SIGNED AND DATED BY THE OWNER. 0 <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. ? I <br /> CONDITIONS OF PERMIT: pQ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT I <br /> ISSUANCE. <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 p <br /> PERMITTED. �J <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. _ / ;a -U <br /> 6. a DCy `" os3 <br /> Z : (WD� <br /> 7. 0 i : 'O <br /> : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my L� C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of o B <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize Q fD <D : m <br /> that this information I am providing will be relied upon by the Coun off BBu7rn Wisconsi innng whether to is- O <br /> sue a permit. I further accept all liability which may be a result of �q�rpe � formator I am 'providing in this application. I agree to permit county officials c r e [n : 1 antes or other i mauthorized person to have access to the above described premises ny rea abhu" of inspection. m <br /> CD <br /> (D <br /> SIGN HERE <br /> j' SEP' <br /> signature of owner ilding contractor)__ Adate) <br /> ZONING ADMINISTRATOR <br /> ^ yi Fn cn fn dr toM <br /> � N NNNNU1 Ul <br /> Vt NO (T (TOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED C�qjq g 0 0 0 0 0 0 0 <br />