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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <. <br /> r <br /> N O <br /> 41 <br /> l n <br /> OWNER 7e_, ,o Tnr - lA PN r A1� TELEPHONE <br /> Q <br /> HOME ADDRESS ay 3 y Cr(2el5 ,, -Oct t J 'Rd SippO?/er '?ww�1 <br /> r � <br /> EMERGENCY/FIRE NUMBER a42 y ROAD NAME <br /> J � <br /> LEGAL DESCRIPTION (see tax receipt) rVe y� O F -L,y Sp L 3 T 35 N R Iy W N <br /> CD <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE X ADDITION ❑ PRIVY ❑ rn 0 <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING CAMPING UNIT SUBD SI N ❑ o. <br /> STRUCTURE/ADDITION USE: Q 0 Yl <br /> (Home/ abin; Commercial Business; Bedroom; Deck; etc.) U) <br /> n ' / II d <br /> BUILDING CONTRACTOR: Amelzf(,+M►.i I14OMtfS 144%gWAI^6 m <br /> v <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> -A N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O `m <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). <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 <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <br /> ��o <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. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. f ) <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT raj <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 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 6. <br /> 'p N y (A O = 3 <br /> 7, o m �� <br /> m <br /> _ - O <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G) C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m <br /> all information contained in this application(including any Ing schedule)and I further declare that I recognize CD <br /> that this information I am providing will be relied upon ' sconsin in determining whether to is- O <br /> sue a permit. I further accept all liability which may be t n ng on this information I am , <br /> providing in this application. I agree to permit count icials c it r ounty ordinances or other <br /> authorized person to have access to the above descri remises at any reasonab r the purpose of inspection. m CDm <br /> ID <br /> (Z �� JUL 1 ` 200101;il <br /> I o 1 <br /> SIGN HERE � <br /> (signature of owner ildin p1T� /�ZONING ADMINISTRATORrl "— <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> V � <br />