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`Jn cal� <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 O <br /> APPLICATION FOR LAND USE PERMITS 3 4 <br /> r <br /> r/ y, N O� <br /> OWNER ��3v�1 TELEPHONE CL <br /> e w <br /> HOME ADDRESS 01T,1 <br /> EMERGENCY/FIRE NUMBER ;yL`Q ROAD NAME)-,::z YY-;j: <br /> LEGAL DESCRIPTION (see tax receipt)s�T3s� X S a-c e y �� 6r/L o7j oT m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE AD ION ❑ PRIVY ❑ VD o <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ / \ a <br /> / 5. <br /> STRUCTURE/ADDITION USE: V C w u r ?6[�1 y <br /> 1 0' <br /> (Home/Cabin; Commercial Business; edroom;Deck;etc.) w <br /> m <br /> BUILDING CONTRACTOR: <br /> m63 <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 -• � <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) Q <br /> O o. <br /> T o'�) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> m m— <br /> NORTH(N). C 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. 1 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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <br /> , ., <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTORETCTHE PLANS N <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN J <br /> q o f n <br /> NEEDED. Il <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. oZ <br /> CONDITIONS OF PERMIT: <br /> ((��1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ALJ <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 /> 3n OM CL M <br /> m C wo N o <br /> 7. c H (Q <br /> _co x <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my C p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m 0 C <br /> all information contained in this application(including any acc sclare that I recognize m m <br /> that this information I am providing will be relied upon by the lr s i `tirmining whether to is- E p <br /> sue a permit. I further accept all liability which may be a result f I Als Information I am m' ; <br /> providing in this application. I agree to permit county officials c rged with administering coun ordinances or other m <br /> 'horized person to have access to the above described premises t any n le ti r the urpose of Inspection. T <br /> (signal f owner or build ng contractor) CO (date) <br /> IINISTRATOR /p ZONING <br /> �53aa-� NNtoNoNP <br /> P cno�ncnoo <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 <br />