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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 /> N <br /> CD <br /> •, (/�(�J� �G <br /> ,2-, <br /> N <br /> -M <br /> a OWNER TELEPHONEV/a q� 3� /777 c <br /> HOME ADDRESS f i vo 1�(jYPY fPAaiA;-C / r v <br /> 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) �- <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ DA DITION ❑ PRIVY ❑ ((�yv�{ y <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING CAMPING UNIT SUBDIVISION ❑I S. <br /> STRUCTURE/ADDITION USE: 670ef/ed LVa 0 <br /> ome/Ga I ; Cyo�m rclal Business; Bedroom; Deck; etc.) rn c� <br /> BUILDING CONTRACTOR: Ja I�)�/ I tS <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 = <br /> A N 41 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T o z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m o \ 'b <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). N o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <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. 111 <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 1 0. <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> o O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN Cr ° <br /> NEEDED. a Z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 0 1 <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT -lj ` <br /> ISSUANCE. V.1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 11) <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY d <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> �( 5. C�yw�/,t�,, -� O -� ; o <br /> " �t�f�iClGtvf� C(,Q f!G207UYC (� (^— J _ G �Q�_�. �.� Q <br /> 7. 1/fes/JOU V/ //�-'h CL- o : y 5 '� ,o -i <br /> —�: m <br /> m <br /> I declare that this application (including any accompanying sche e) has been e e e and to the best of my G3 c ID <br /> knowledge and belief it is true, correct and complete. I acknowle that I sjonsibi r tail and accuracy of a 0 C <br /> all information contained in this application(including any accompanying s6fl�i1. d I furthe are that I recognize \ o o m <br /> that this information I am providing will be relied upon by the Couurnett 1 In dete ining whether to is- <br /> sue a permit. I further accept all liability which may be a result of the If Burning this information I am ; <br /> providing in this application. I agree to permit county officials charged tering co ordinances or other m <br /> authorized perso to h e access to a above des d preAl es at an r t urpos of inspection. m <br /> CD : <br /> SIGN HERE � . . <br /> (signature of wner or building V ct r) (date) <br /> ZONING ADMINISTRATOR 40' <br /> N N (IN N <br /> fly Ut O N U P P <br /> O O <br /> T SHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br /> / 0000000 <br /> V(Lat'C- <br />