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CJv v� <br /> Burrett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v c) z <br /> APPLICATION FOR LAND USE PERMITS 3 ° <br /> r <br /> N .0.. <br /> OWNER DE kH I C NI SS TELEPHONE I7_CI GSy So4z. O <br /> lJ w <br /> HOME ADDRESS4• jn uT • (Kwt o g Rp PAG& L MI`I SS►77 v <br /> r m <br /> EMERGENCY/FIRE NUMBER ZA946 ROAD NAME vw Yt�Lnw ►�ueLRD ( 1� <br /> OAI�L AND <br /> LEGAL DESCRIPTION(see tax receipt) N 14 of S`' 14 AzyA➢Z 7 40 t i,K (b W.-raw N or` c <br /> 0 <br /> TYPE OF PERMIT(S): <br /> DWELLING/BUILDING1:1 GARAGE/ACCESSORY STRUCTURE 50 ADDITION ElPRIVY ❑ 1 rn o <br /> FFILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ L:STRUCTURE/ADDITION USE: rArtAC�E o(Home/Cabin; Commercial Business; Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: O`NN Ftz <br /> v <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. <br /> O — <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING• (AERIAL OR TOP VIEW) O CD O <br /> n _a <br /> m z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. v <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). C 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO CO) <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF 1 <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. <br /> S. 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 I 0 d <br /> MUST BE SIGNED AND DATED BY THE OWNER. o I <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. <br /> .� Q <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z <br /> CONDITIONS OF PERMIT: P 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. (1� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. CYi , <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY }`J IW, <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER U7 <br /> SETBACK AREA. <br /> 5. <br /> z v 0 r v> 0 -0 <br /> CD d m m <br /> 6. N << C.N m Q rZl <br /> M C N <br /> 7. Z N NO <br /> � tC <br /> O 1 : ,ZI <br /> _ Cn ; m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my tj c ' : : O <br /> knowledge and belief it is true,correct and complete. I ackn ha I am responsible for the detail and accuracy of d I, C <br /> all information contained in this application(including any aap i eclare that I recognize �m f m <br /> that this information I am providing will be relied upon by th r s i ining whether to is- v <br /> sue a permit. I further accept all liability which may be a res n r r this information I D) <br /> (0 <br /> providing in this application. I agree to permit county offic' charged with administering c n ordinances or other m <br /> authorized person to have access to the above described pr as at alW nab[ for It rpose of inspection. <br /> m <br /> SIGN HERE 5 <br /> (signaiuurre"off o ner or UN building contractor (date) <br /> ZONING ADMINISTRATOR `J 11�� Id(�( ZONING <br /> fnwwviFn <br /> N(T NNN <br /> CnOO1N0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 I <br />