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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o° Z <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> CD <br /> N � <br /> OWNERDO ki h l l as TELEPHONE -715- G 56- 3 ZFIo v <br /> HOMEADDRESS 3/7,,?7 SfafG �+yy 3S !/c?ti bar y (.c�Z 5 83a v &D <br /> r <br /> 0 <br /> EMERGENCY/FIRE NUMBER 31737 ROAD NAME S fa f C fi�� 35- <br /> LEGAL <br /> 3SLEGAL DESCRIPTION(see tax receipt) CO) <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ® ADDITION ❑ PRIVY ❑ rn ` <br /> TYPE OF PERMIT(S): Q <br /> FILLING/GRADING ❑ CAMPING UNIT 1:1 SUBDIVISION ❑ ..y -/ <br /> STRUCTURE/ADDITION USE: S l GLC <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) rn <br /> m <br /> BUILDING CONTRACTOR: Drt�vi�,h to <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. n 3 <br /> O ir <br /> M In <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). N c <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. 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. O <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. IV <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS W <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> o � � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q <br /> NEEDED. 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z (� <br /> 0 <br /> CONDITIONS OF PERMIT: <br /> t7 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT I Q) <br /> ISSUANCE. 1 <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. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> m m mn m <br /> 6. (D 'CD a. <br /> ' 3 <br /> 7. .0i :, <br /> _a) m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c p <br /> d: C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m m <br /> all information contained in this application(including any accompanyi clare that I recognize ' M <br /> that this information I am providing will be relied upon by the County IEVEEEFU)11 <br /> ing whether to is- O <br /> sue a permit. I further accept all liability which may be a result of the 'information I am <br /> providing in this application. I agree to permit county officials chaff d with administering county o in'ances or other m E <br /> authorized person to have access to the above described premises y reas a ime f r the purp of inspection. T <br /> a <br /> m : <br /> CD : <br /> SIGN HEREI _ — bb <br /> (signature of owner or building contractor) TT COUNTY (date) <br /> ZONING ADMINISTRATOR `-lim, rhn�q2b, ZONING <br /> ✓% N N N N N V (r <br /> Vt Vt O Vt N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 0 0 0 0 0 <br />