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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator �v G) Z <br /> ` APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> N <br /> CD <br /> CL <br /> OWNER ^ �^� To �� OeA�Iq LLp TELEPHONE d r1- 76 z '$3 $O <br /> m <br /> / CD 00 <br /> HOME ADDRESS RS pv1 S Lr-rn �^R�cs Mme✓ SYc�/ <br /> CD <br /> EMERGENCY/FIRE NUMBER 4V / �L ROAD NAME C <br /> LEGAL DESCRIPTION see tax receipt) ' ^ <br /> ( 10 �sce 15--4L ,s�r� ?moi nl, Qa-,¢ 14 � ) <br /> 0 <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION El PRIVY G <br /> TYPE OF PERMIT(S): v <br /> FILLING/GRADING ❑ CAMPING UNIT t❑ SUBDIVISION ❑ <br /> a <br /> STRUCTURE/ADDITION USE: fly wyo-f L$Df 1 �{ C.��J Qi Q� o <br /> (Home/Cabin; Commercial Business; Bedroor�i; Deck;etc.) y <br /> BUILDING CONTRACTOR: ( � 'Mfg^• N �"► e- a �+O v l��iLCtina..T y., <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/1 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m <br /> M N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> n n <br /> TZ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m v z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <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 Im <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 /> 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. = c <br /> v � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN Cr S W <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: c <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 1 <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 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. r7 y/� L J <br /> J � v0 � o vm <br /> 6.5. / / LA-ke bd arca 'r /7117 . � a y 6= Z <br /> m c y 0 5 3 <br /> 7. Z : <br /> m � � . i <br /> o : <br /> w : m <br /> I declare that this application (including any accompanyi c edule) has been examined by me and to the best of my i p <br /> knowledge and belief it is true,correct and complete. 1 ac* onsible for the detail and accuracy of m C <br /> Cl <br /> all information contained in this application(including any i g e ffhW declare that I recognize m <br /> that this information I am providing will be relied upon by� �1 oo I terminin whether to is- O O <br /> sue a permit. I further accept all liability which may be a It of the County ooBBUfn I OIon this information I am m <br /> providing in this application. I agree to permit county o i als chthadministerin q¢nty ordinances or other m <br /> authorized person to have access to the above des ri a ises ipfLlfy asor,l ime f purpose of inspection. T <br /> PC, <br /> SIGN HERE T ONT <br /> nat r o ne ui c r tor) QN�NG (da )ZONING ADMINISTRATOR ) Ul NNOWNSHIP PERMITS MAY BE REQUIRED 00/ <br /> 0000 <br /> 0 <br />