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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator�rr- 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> N 0 <br /> C <br /> / y� / /� �TFp�{p d <br /> OWNER yLU'-�1/ITLLY NE <br /> o <br /> HOM DRESS ��1_- G�� ✓l/-1� �I v CD <br /> -3s v rCD <br /> GENCY/FIRE NUMBER / O�� ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) o� <br /> *X7 <br /> CS'm Y2 O 6� r£ Glt; <br /> >p <br /> 0 <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ , rn = <br /> TYPE OF PERMIT(S): Q <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> S. <br /> �/ H <br /> STRUCTURE/ADDITION USE: ff by/'! rrr4 <br /> (Home/Cabin; <br /> Commercial Busizye <br /> ; Bedroom; Deck;etc.) Cn <br /> _ <br /> / Y _ <br /> BUILDING CONTRACTOR: 7 � � <br /> o r £ cn �� C 417— S,' <br /> 1 <br /> 71 <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. O <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p c C d <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m (R <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m E v 1 <br /> NORTH(N). C <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m y� a <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF JN <br /> v <br /> " LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 1 0 <br /> 0SHOW 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. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS I �� <br /> MUST BE SIGNED AND DATED BY THE OWNER. e <br /> O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHENq o <br /> NEEDED. 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT f <br /> ISSUANCE. Q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY �4 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER SETBACK AREA. <br /> CD W <br /> 01 �C <br /> a � v � vLv <br /> 6. m 3 am 0,Q � <br /> mC:Rw0 3 <br /> 7. Z <br /> o <br /> = cn : m <br /> I declare that this application (including any accompanying schedule) has been, 4deiln <br /> the best of my Lj p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am <br /> 'a mist and accuracy of o C <br /> all information contained in this application(including any accompanying sch�ule)and I f <br /> I recognize m m A <br /> that this information I am providing will be relied upon by the County of Burr tt Wis sin in hether to is- (^ O <br /> V1 <br /> sue a permit. 1 further accept all liability which may be a result of the County-of Buri l n on this I am m <br /> providing in this application. I agree to permit county officials charged with ministe in o rdinan s or other m <br /> authorized person to have access to the above described premises at any rea a forth ose o 'nspection. m <br /> m : <br /> Q : <br /> SIGN HERE IO/ViA <br /> C® ® _ <br /> (signature of owner r bu ding contracto (date) <br /> ZONING ADMINISTRATOR anQ <br /> N K) (n NNCT0 <br /> • w UiONtr00 <br /> "-VF E'RMITS MAYBE REQUIRED g 0 0 0 0 0 0 0 <br />