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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 /> U1 <br /> �/ ! <br /> OWNER <3tj6.3A�•�J�i'� �Ss,J TELEPHONE /lQ Z' / O p -04 J <br /> l o(Q 3 k�c��L .. <br /> HOME ADDRESS <br /> EMERGENCY/FIRE NUMBER �2g?j ROAD NAME j6kSS x4ke"C- <br /> LEGAL DESCRIPTION(see tax receipt) p'r CSM � f S' &44 (� W <br /> �)n c <br /> DWELLING/BUILDING ElGARAGE/ACCESSORY STRUCTURE ADDITION 10:1PRIVY ❑ v ur 0 <br /> TYPE OF PERMIT(S): lJ a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n \ <br /> Q, I, N 1 <br /> STRUCTURE/ADDITION USE:ae, A{ 0Z i. ii <br /> A <br /> (Rome/Cabin; Commercial Business; Bedroom; Deck;etc.) d <br /> BUILDING CONTRACTOR: <br /> M <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) <br /> m <br /> T CL <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C -'Z) 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <br /> v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. I ° <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. VJ o <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS 1 <br /> MUST BE SIGNED AND DATED BY THE OWNER. ro <br /> o L <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN Cr <br /> NEEDED. tt L <br /> 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o Q <br /> CONDITIONS OF PERMIT: 5. <br /> 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT O <br /> ISSUANCE. W <br /> C <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ( ,I <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY 'm <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AUA. <br /> 5. nf� -/7 J a ��c�- / g <br /> @ N O O 0 <br /> Z C <br /> 7. P te : ;a <br /> I declare that this application (including any accompanying schedule) In b me and to the best of my L7 C <br /> knowledge and belief it is true,correct and complete. I acknowledge that o ktail and accuracy of cE,all information contained in this application(including any accompanyin sc �J�rt�de/,that I recognize m m m <br /> that this information I am providing will be relied upon by the County' urnett Wisconsin In dAIt whether to is- m t7 <br /> sue a permit. I further accept all liability which may be a result of the unty�ett relying on this formation I am m <br /> providing in this application. I agree to permit county officials charg with IsleO or nances or other E m <br /> authorized person to have access to the above described premises at any reasonable tim f p rp of inspection. 'n <br /> NEnCO CD : <br /> SIGN HERE ISI ISI <br /> IUR *kZ_C0_ <br /> lure of owner or bui in contractor) IY (date) <br /> ZONING ADMINISTRATOR �' ' <br /> 49 40 <br /> N NN N01 <br /> N C11n P O fl1 NO0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br /> 0000000 <br />