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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. <L <br /> 57 0r <br /> OWNER :TE AQ A '2_'TELEPHONE ��i.J — _/1(J�'S�' <br /> m <br /> n 1 /_ c° <br /> HOME ADDRESS W �a (�p/�[ ��ie L44t� M 0 503/10 �j <br /> EMERGENCY/FIRE NUMBER�Ir�/� (•. �O + ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) el Idl �/3 3 _ 3Q_1jL-+ y <br /> DWELLING/BUILDING �GARAGE/ACCESSORYSTRUCTU�❑ ADDITION ❑ PRIVY /❑ - 0 <br /> TYPE OF PERMIT(S): y c <br /> c � <br /> c <br /> FILLING/GRAD,,eI,,N``G--❑ CAMPING UNIT ❑ SUBDIVISION ❑ n `j <br /> STRUCTURE/ADDITION USE: ('.11 O ��`/ k�5 /11AKAJthe <br /> (Home/Cabin; Commercial Business; Bedroom; Dec etc.) y V�J <br /> BUILDING CONTRACTOR: <br /> .� <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR ' <br /> In 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. W <br /> M N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O M <br /> n a <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 m 'o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m IF <br /> NORTH(N). y 3r <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 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. Z 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 /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 1�� N p`1 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS t <br /> MUST BE SIGNED AND DATED BY THE OWNER. o W <br /> o 0 W <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN a <br /> NEEDED. C W <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z 1 <br /> CONDITIONS OF PERMIT: <br /> (� 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. I <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY O <br /> PERMITTED. C <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. XIS h►� N (o/ - /) 0u �Z . 4J � r o o vvow ni ).o f- 75 649 <br /> 6. be IAW f0 lul�ltl tNh��L 1��oT /^� �0 1° —ilu < 9 QN ma <br /> a <br /> 7. � ✓e i aid tv ►nest 7S s-P_ �A c frim a o y '° =t <br /> rE La Cr <br /> m <br /> I declare that this application (including any accompanying scq has been examined by me and to the best of my p <br /> knowledge and belief it is true, correct and complete. I acknow responsible for the detail and accuracy ofErn -, x <br /> all information contained in this application(including any c nd I further declare that I recognize m m <br /> that this information I am providing will be relied upon by ounty o I� in determining whether to is- p <br /> sue a permit. I further accept all liability which may be a It of the County uF ¢[t g on this information I am m <br /> providing in this application. I agree to permit county o i Is ch with admit n my ordinances or other m <br /> authorized person to have access to the pbove described preLpises at a roa n pble time !'purpose of inspection. -n <br /> RNF `! <br /> SIGN HER <br /> nat re of wnerorbuil n tor),C( A„ (date) <br /> ZONINGADMINI T ATOR <br /> Fn ri fn w N) <br /> • N N(l1NN U� <br /> V1 CT O N V1 O <br /> WNSHIP PERMITS MAY BE REQUIRED ° 0 0 0 0 0 <br />