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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m o 0 <br /> r ,APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> VT o <br /> N <br /> m v \ <br /> OWNER -�-1 M I C Fon TELEPHONE 6 ,;� _6120 _ 773 y <br /> �? <br /> HOME ADDRESS u-?()D DA)P_ pr'. did "4^o P►/✓ s 5-902CI O <br /> I r m <br /> 0 <br /> EMERGENCY/FIRE NUMBER aq 1'71 ROAD NAME For d Rd, <br /> L_qCS V 1 ao N ujly E <br /> LEGAL DESCRIPTION(see tax receipt) T. 4 o N. I` � �SW, SLoO. 0, <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION PRIVY ❑ <br /> TYPE OF PERMIT(S): l it <br /> FILLING/GRADING ❑ CAMPING NIT ❑y SUB VISION El S. <br /> a <br /> STRUCTURE/ADDITION USE: nd Ie VC I �o X S ao <br /> (Home/ bin; Commer lal Business; Bedroom; Deck;etc.) rn <br /> m <br /> BUILDING CONTRACTOR: T I C e CDILS�- <br /> v <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 /> M y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 o <br /> in <br /> T 0 Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> NORTH(N). y 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m3 <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. Q <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 p <br /> MUST BE SIGNED AND DATED BY THE OWNER. c <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN W <br /> NEEDED. 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <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. 1 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY BO <br /> PERMITTED. (1f <br /> 4. NO STRUCTURES, INCLUDINGRETAIN ING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER Jv( <br /> SET ACK AREA. <br /> 5. �1L 1/, <br /> m <br /> 6. m DoCDPor M <br /> ID c N N m s 3 <br /> 7. o y �'< : i .'0 <br /> _ rn : ' m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my L7 c C <br /> knowledge and belief it is true, correct and complete. I ackno dge that I am responsible for the detail and accuracy of o <br /> all information contained in this application(including any�, schedule)and I further declare that I recognize M <br /> m m <br /> that this information I am providing will be relied upon bit tiLe Cpur1r Wisconsin in determining:yvhether to is- O <br /> sue a permit. I further accept all liability which may be resu t quty(df t{rnett relying on this information I am <br /> providing in this application. I agree to permit county fficials charge hl nIttstering county ordinances or other : m <br /> authorized person t ve access to the above descri pre t any reasona'blgirite for the purpose of inspection. T <br /> CD <br /> a / <br /> m <br /> p <br /> SIGN HERE 3 _... `— 1T 00 <br /> Is natur of owner or building contr Vr <br /> C (date) <br /> o <br /> ZONING ADMINISTRATOR d+ <br /> <a to to tnwCA <br /> N UG r�juN(T N V7CA <br /> 0 <br /> Ul fn Ofn 00 <br /> 90W,NSHIP PERMITS MAY BE REQUIRED <br /> 0000000 <br />