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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 go <br /> Office of Zoning Administrator C,t� - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> 57 0 t� <br /> OWNER a ✓ ` �u , mow, s TELEPHONE 7L 71� YS �2yO \' <br /> m <br /> W <br /> HOME ADDRESS13N S- rCy <br /> 9. n <br /> r' L,/., .- W m <br /> 0 <br /> EMERGENCY/FIRE NUMBER 2 :7 y r- ROAD NAME <br /> —�` <br /> LEGAL DESCRIPTION (see tax receipt) 6 J .r-� A�pGS 0 90 c <br /> DWELLING/BUILDING ❑ GA/ �RAGE/A�CCESSSORY STRUCTURE El ADDITION PRIVY ElI U /�o t� <br /> TYPE OF PERMIT(S): Cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ L1 <br /> STRUCTURE/ADDITION USE: 8 e- Y O o yl1 rt-rl.JQ L.eLw y <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etcA Cn <br /> m <br /> BUILDING CONTRACTOR: <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81AX 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 11� <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n = v <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n 0 :b <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m C <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. 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. 0Q <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. ,o c <br /> O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q 1 <br /> NEEDED. 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <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 Y <br /> PERMITTED. / <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> CD W D t' M <br /> 6. �' � 3am Rra <br /> '4 C N N 3 <br /> 7. Z N f D <br /> O <br /> 0) <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c p <br /> ' <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m C <br /> all information contained in this application(including any accompa schedule)and I further declare that I recognize m m . m <br /> that this information I am providing will be relied upon by the Cou consin in determining whether to is- l7 <br /> sue a permit. I further accept all liability which may be a result of ty o l� ng on this information I am m <br /> providing in this application. I agree to permit county officials'c rge � t ordinances or other m <br /> authorized person to have access to the above described premi at any reasona li se of inspection. m E E <br /> AUGCD <br /> SIGN HERE > 9 <br /> (signature of owner or building contractor Uri (date) <br /> NE7?C <br /> ZONING ADMINISTRATOR �)m OaaAolJ��d. 011A ° Fn <br /> N N N N V <br /> Ut ut O V1 O <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 0 c3 <br />