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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872Office of Zoning Administrator 0 G) Z <br /> APPLICATION FOR LAND USE PERMITS 3 C°\ <br /> r �l \ <br /> UT 0 ���JJJ <br /> 41 <br /> OWNERo f <br /> ( Ad <br /> S U TELEPHONE q(7 - K y y <br /> m <br /> �( <br /> HOME ADDRESS ( t ti /lS 6V t N1 y <br /> Il f '41 N 5. 337 <br /> r � <br /> EMERGENCY/FIRE NUMBER 3-7 Pjj ROAD NAME 4 c o v L,f le <br /> I <br /> LEGAL DESCRIPTION (see tax receipt) £tT ro.r �owr yu <br /> kA✓S f /f enT Cs r, V/ P/Y7 Cl) <br /> CD <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ , ti o <br /> TYPE OF PERMIT(S): � � � <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> n <br /> STRUCTURE/ADDITION USE: DEC (C <br /> o' <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) <br /> m <br /> BUILDING CONTRACTOR:— S£f F ? n <br /> m <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 /> DIRECTIONS FOR PLOT PLAN DRAWING• (AERIAL OR TOP VIEW) O a <br /> m <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T ? <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m o <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. Z <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO o <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 /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR,ETC.,THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. 2 o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. Y <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 Q <br /> ISSUANCE. n <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 �y <br /> SETBACK AREA. �J <br /> 5. <br /> 6. m MWM0 CL M <br /> m � 3 o. m nm <br /> a m cN o s7. <br /> 3 <br /> Z : <br /> o -n� <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my �j C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o m <br /> that this information I am providing will be relied upon by the Coun rn tt Wisconsin in determining whether to is- ID <br /> C <br /> sue a permit. I further accept all liability which may be a result of in on this information I am d <br /> providing in this application. I agree to permit county officials t Is r inances or other <br /> authorized person to have access to the above described premiss any re i r e of inspection. <br /> CDm <br /> d �'I m <br /> SIGN HERE U s i e E <br /> (si atu ofo <br /> wbuilding contractor) date) rv+ <br /> ZONING ADMINISTRATOR �� B�fR�� <br /> `1 <br /> ZONING <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />