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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> N <br /> OWNERw.� SRuN�,s4,rl�a Sew tl� ,IIA ( ka-Rag-ogV <br /> 1 � <br /> HOME ADDRESS L{►� �O W �e.S �tl�c� h \{��� ltm'A) h IJ' `� J� <br /> EMERGENCY/FIRE NUMBER �116 O &tj J �Q ki I�R-�YQANAME y ��L� Rz" ( e <br /> LEGAL DESCRIPTION (see tax receipt) ` 00 _ G L. Kir s te/ !j b m <br /> r, <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITIONPRI ❑ N 0 <br /> TYPE OF PERMIT(S): 9, v <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ 5 <br /> STRUCTURE/ADDITION USE: 'aAV, _VoLA /k 0 <br /> 0 <br /> (Home\/Cabin; Commercial Business; Bedroom;Deck;etc.) a Q <br /> BUILDING CONTRACTOR: �2�t1'�0 YV 0 !J 1 Z ISI G <br /> N <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. p <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o O <br /> TAL <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m � � I_ <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m �? <br /> NORTH(N). y 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO nl o <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. oZ <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 p <br /> MUST BE SIGNED AND DATED BY THE OWNER. 0 1 <br /> _o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN '" o <br /> 4 W <br /> NEEDED. 0 � <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z (� <br /> CONDITIONS OF PERMIT: <br /> c <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 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> co d N m <br /> CL <br /> 6. IPS 3 am �-a.x <br /> w N C N N O 3 <br /> 7. G N N O f0 <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Q c C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of o <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize AC' CD <br /> N m <br /> that this information I am providing will be relied upon by the County 0, isopnsin in determining whether to is- �? o <br /> sue a permit. I further accept all liability which may be a result of tli n t11(ing on this information I am m <br /> providing in this application. I agree to permit county officials charged g aunty ordinances or other m <br /> authorized person to have acVqss to the above described premise at any reasonable time f6Ttddt Viepurpose of inspection. n <br /> OCT q� CD <br /> SIGN HERE <br /> (sigatu oPbwneroir i gcontractorBURs c (date) <br /> ZONING ADMINISTRATOR TT COON' r f_n <br /> v+to 69 w cn <br /> N N01NN O1 <br /> O (n OOl OO <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0o 0o c C, 0o <br />