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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v I ° z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> F O <br /> N <br /> G <br /> OWNER �iGj�E+�./� TELEPHONE 4g�v—49epv—QC�jy <br /> o W � <br /> HOME ADDRESS �j/ iQ�i EQi Okf Av-541 Z'�IZ v C <br /> 0 <br /> EMERGENCY/FIRE NUMBER OAD NAME <br /> 1�07 3 C 5 47 ✓s P /3S— <br /> LEGAL DESCRIPTION (see tax receipt) 4,07 Al (_' 5ir) 119P )3 G 0? Ml-i__ I m <br /> 0 <br /> e: <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ Cl) O <br /> TYPE OF PERMIT(S): c <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ c <br /> STRUCTURE/ADDITION USE: t. U�'/°��Tfl� 3t)X qS c <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) rn <br /> BUILDING CONTRACTOR:�J�iCA�O1% �sC.���/� <br /> M <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p n:_ <br /> �;.,,xvrza.,�dnw.ra0wn"r:r:y.D:aada:,wo.�.f�eaa.Asc:sHwYw,W:.:xams�rcvntN.data.3aaseMMW*..T.ti�4A.Pd;aS'#.2ta�,cRF';a4,�`�«u3..;..rtuitiRw,at!+p�,. � C <br /> (AERIAL OR TOP VIEW) �sr w y� O M <br /> n CL <br /> T Z <br /> ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 0 z <br /> SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). Cn \ 3 <br /> 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. P <br /> SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO g <br /> BUILDINGS,ROADS,LAKE, LOT LINES. 0 <br /> INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. y N <br /> IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLAN <br /> MUST BE SIGNED AND DATED BY THE OWNER. $o <br /> ° 9 <br /> TE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN a <br /> NEEDED. <br /> T PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. a c <br /> CONDITIONS OF PERMIT: ` p <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. V <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. t <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. 5� Q <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRE ,4t <br /> SETBACK AREA. / <br /> 5. y y <br /> (D M. o0i Fi Li° m <br /> 6. w/ / m,� � n� �Cc .9 <br /> 7. z : <br /> \ p G x <br /> I declare that this application (including any accompanying schedp e� t7as been a arniried,.by, to th of my; ? 3 c m <br /> i A <br /> knowledge and belief it is true,correct and complete. I acknowled ��is���n ro, fj;if�le,,' Qt�d and ac racy Q+ n <br /> all information contained in this application(including any acco Hying s2ti'e6e J 15Qd f/ rthet.. r Sfiat I recog 7e m ; : . m <br /> G7 <br /> that this information I am providing will be relied upon by the ty of Burnett Wisconsih iirditerm 9 Wloettier o is- m O <br /> sue a permit. I further accept all liability which may be a result he CoiM�rlfJ}u�ne ying o j this informal,, I am m <br /> providing in this appl, atio I agree to permit county officials arged wit a cou ordinances or other m E <br /> authorized person v ccess to the a>qve described premises reasonable tim or th pose of inspection. <br /> livt:TT m <br /> CD . <br /> S NZONIAJG UNZ—w— <24 <br /> (sl ature f ner or bu n ontractor) (date) <br /> ZONING ADMINISTRATOR <br /> vi fn fnrntnt»� <br /> N NONNCn Vt <br /> Ij335 �, p, o �� oo <br /> TOWNSHIP PERMITS MAY BE REQUIRED Co °0 0 0 c no°0 <br />