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Burnett County 7410 Co. Rd. K, No. 102, Siren,W154872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> N <br /> race <br /> OWNER �Q;' � � <br /> TELEPHONE � I S- O 3 S-to D n s <br /> m <br /> + O <br /> MAILINGADDRESS 159 �� 6L V-\ �SV06hf.,�r QQ <br /> p c (� 0 <br /> - <br /> PROPERTYADDRESS 115q 'P�A YY\Q r LAY, e- JPQ�Vt QN' -*c <br /> LEGAL <br /> LEGAL DESCRIPTION(see tax receipt) <br /> VV m <br /> A <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION El0 <br /> TYPE OF PERMIT(S): _ <br /> Q <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ 5 <br /> STRUCTURE/ADDITION USE: 5r�ra_n a,�_ o <br /> t <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) 0 ^ n` {. <br /> BUILDING CONTRACTOR: m <br /> 0 !O <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> A C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O T c, <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 0 � 30 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> C V O <br /> NORTH(N). m 1� 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF t Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. b ° <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. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. ro E <br /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN - ° 3 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o " I <br /> CONDITIONS OF PERMIT: <br /> Q) t � <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ({ t IT 1 <br /> ISSUANCE. VJ <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 <br /> SETBACK AREA. <br /> 5. <br /> X cm o0im 0m n : m <br /> 6. > 7 2 d � <br /> m s3 nmx .� <br /> a omcN `.' o53 <br /> cto -1 <br /> 7. o m : T m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m O <br /> PP ( 9 Y ) Y y N C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of .moi : n 2 i A <br /> all Information contained in this application (Including any accompanying schedule)and I further declare that I recognize im . : O <br /> that this information I am providing will be relied upo y the County of Burne Wlsconsin in determining whether to is- <br /> O s <br /> sue a permit. I further accept all liability which may a result of the Cou f Burnett relying on this information I am m o <br /> providing in this application. I agree o permit cou y cials c arged ad istering county ordinances or other <br /> authorized pe n to have access tote abov esc be premi ata a time for the purpose of Inspection. m <br /> D <br /> aa : <br /> SIGN HERE P Ir <br /> � <br /> (signature of ow er or bu ng kontractor) date) [ <br /> ZONING ADMINISTRATOR <br /> O O N O N N N O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> T"PERMIT SHALL EXPIRE ONE YEAR FROMATE PF ISSUANC <br /> rn ;i� � e �picteAup �y grace RA s3^2 b � <br />