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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 /> N � <br /> N <br /> C ' <br /> n <br /> OWNER Day i(j M OS Qg TELEPHONE ( o16416 ^p <br /> O <br /> HOME ADDRESS `zg430 5toneaate Rd Webster A 5412A3 = <br /> r � <br /> 0 <br /> 27430 ROAD NAME Sfo fjWfttp� RGI <br /> EMERGENCY/FIRE NUMBER <br /> rT TfR1( yq J rnn - <br /> 33-I� 28 30Cn 33/ I�FU/ K tto yv „u� .�o�fv <br /> LEGAL DESCRIPTION (see tax receipt) 99._40-I tD-3.3•0 0300 lot 1 CSM V3 Poo Lt.oaVCD <br /> ii LL o ' <br /> DWELLING/BUILDING � GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ IOL � , W _ <br /> c <br /> TYPE OF PERMIT(S): <br /> n <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ , <br /> ' 1 0 <br /> STRUCTURE/ADDITION USE: "omP/ t►, <br /> (Home/Cabin';�-C,ommera � <br /> 'P� al Business; Bedroom; Deck,etc.) � W <br /> BUILDING CONTRACTOR: ftle uilciPrS '!„_�-s - <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81h X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 ur ` d <br /> 0 y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n a <br /> M O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE N o <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m z <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF o <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <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. v N 0 . <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS ?, '-j <br /> o <br /> MUST BE SIGNED AND DATED BY THE OWNER. II <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN r ^ <br /> NEEDED. fol�J v� !w,' <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. -L') C41 W <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ` d <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 <br /> s. LAR'EA <br /> W mNymN: a m <br /> aCyFz6� /46IIai��l� m <br /> 6. B,SI,J /� � UrrI`W �"OP' a- : � <br /> /4 �e 0� CD <br /> O3� <br /> o : —,:2 <br /> m <br /> 7. <br /> I declare that this application (including any accompanying sA I mined by me and to the best of my - 2 c <br /> tail and accuracy of <br /> knowledge and belief it is true, correct and complete. I ackno I a y m <br /> all information contained in this application(including any acc a a lave that I recognize p <br /> that this information I am providing will be relied upon by the my of Burnett I o i r fining whether to is- <br /> sue a permit. I further accept all liability which may be a res I the C of Burnett relying n t is information I am <br /> providing in this application. I agree to permit county offic' harga ruing co It ordinances or other <br /> authorized person to have access to the above described pre s at any reasonablerfor It rpose of inspection. <br /> CD <br /> URNETICD <br /> COUNT- <br /> SIGN HERE (date) <br /> (signature of owner c ra ( •: <br /> 0 <br /> ZONING ADMINISTRATOR <br /> TOWNS IP PERMITS MAY BE REQUIRED <br /> l7 <br />