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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 /> y O <br /> N <br /> _ C T <br /> ��-�� W 1 +7 D t/ C \X! <br /> CD <br /> OWNER V' ACJ 1 cl r 1 q �� C3 TELEPHONE 5U7 r L O / p <br /> (Z S E �c'r�ch�st c <br /> MAILING ADDRESS ' 7'7 Z f��C S+C f" M nn S 5 9 0Y <br /> r m <br /> 0 <br /> PROPERTYADDRESS !3 V 52I lae t-b. Lake- 'Tro.. L , ��^�"�`� l� r S� • <br /> dot /3 Lost etc-rc$' — � <br /> LEGAL DESCRIPTION(see tax receipt T5e- I/q 5c,+ 11 . <br /> 1 TO r- st-j 41 N f-A f1JL C I s w N? I (C� <br /> DWELLING/BUILDING 11 GARAGE/ACCESSORY STRUCTURE ADDITION ❑ f�.r 3.J (n o \ <br /> TYPE OF PERMIT(S): `C <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ o- ' <br /> STRUCTURE/ADDITION USE: (1 f a 5 C Of d o+a r,h e y 30 X 5d <br /> V (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) rn <br /> BUILDING CONTRACTOR: S t • �' <br /> m <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. + m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) #a&h Geri (J O n <br /> T <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C <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 <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. I 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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o - <br /> v J <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN 5i, n <br /> NEEDED. 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: p '`r��, <br /> t DRIVEWAY <br /> 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 /> This structure to be used as private residential m d d > o a f m <br /> 6. 3 ag Fad z <br /> garage/storage only. Not to be used for human �° C v N <br /> 7. habitation. z a m <br /> o Tom : m <br /> declare that this application (including any accompanying schedule) has been examined by me and to the best of myC <br /> C <br /> and belief it is true,correct and complete. I acknowledge that I am responsible for tha-detail and accuracy of m n . <br /> cD �n : m <br /> all information contained in this application(including any accompanying c decyare that I recognize m � o : m <br /> that this information I am providing will be relied upon by the Cou ofd e I o I t r�tning whether to is- D ' t7 <br /> sue a permit. I further accept all liability which may be a result of� ��l o this information I am nO <br /> providing in this application. I agree to permit county officials c� administering coun ordinances or other o <br /> authorized pe have access to the above described premise at any reasonable ti the r ose of inspection. fD o <br /> SIGN HERE .y� Co' �� 0 3 ' <br /> (s''ign11s a of w r or building contractor) BORNE l r V (date) <br /> ZONING ADMINISTRATORy�� ol'/yif-Iy ZONING <br /> fA fA M fR�N <br /> N (T N N O O <br /> CnONfr00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED Al V <br />