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DnCehp <br /> Burnett- ounty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 c) Z <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> OWNER /,I /yj�IlP ti TELEPHONE rl��J Co ✓ (�b o <br /> d <br /> HOME ADDRESS 7l0 S 7G /-cc/-7% <br /> EMERGENCY/FIRE NUMBER ' 'S /�7 AD NAME (j <br /> LEGAL DESCRIPTION (see tax receipt) ;i, /f „� < a r I <br /> CD <br /> �7 0 <br /> DWELLING/BUILDING Lt7 GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ <br /> TYPE OF PERMIT(S): v <br /> FILLING/GRADING ❑ CtMPING UNIT 11SUBDIVISION ❑ n <br /> STRUCTURE/ADDITION USE: <br /> (Hb a/Cabin; Commercial Business; Bedroom; Deck; etc.) y <br /> d <br /> BUILDING CONTRACTOR: <br /> � v <br /> m <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. -n <br /> O <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 o. <br /> In Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 0 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). <br /> n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO 02 0 <br /> 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. o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO 1 <br /> BUILDINGS, ROADS,LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 1 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. n o <br /> v � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN S <br /> NEEDED. 0 Q, <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 <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 G) <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. ifgiy' //[ "CT A n d v DQ o 'O <br /> o : _ Cn m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my of a p <br /> knowledge and belief it is true,correct and complete. I ackyh <br /> hat I am responsible for the detail and accuracy of o C <br /> all information contained in this application(including any dule)and I further declare that I recognize m <br /> M <br /> that this information I am providing will be relied upon by tf u in in determining whether to is- O <br /> sue a permit. I further accept all liability which may bearf t e Ing on this information I amproviding in this application. I agree to permit county offharged wit i Jcounty ordinances or other ? mauthorized person to have access to the above described psNoy,reasonable ti �the purpose of inspection. -n <br /> 46 mE <br /> SIGN HERE Q ,� p`/ <br /> (sIgnat6—reqffwnejor buildior)ng ntrac CO (date) <br /> ZONING ADMINISTRATOR <br /> f» fnviv+cnF»� <br /> N NN .m N <br /> u7 V7 P O V7 U1 0 .0 <br /> O <br /> TOWNSHIP PERMITS MAY BE REQUIRED IT0 000000 <br />