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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> OWNER 1 V„ P� TELEPHONE <br /> O <br /> HOME ADDRESS t&jjWWj LA q t o w <br /> r � <br /> EMERGENCY/FIRE NUMBER O a7o2RO D NAME <br /> O - 4oco--7L— <br /> k! ��wov lan,r <br /> LEGAL DESCRIPTION(see tax receipt) L ('S ✓) Pfd m <br /> e <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION 1:1 PRIVY ❑ ur ° J <br /> TYPE OF PERMIT(S): Cr q <br /> FILLING/GRADING ❑ CAMPING UNIT ElSUBDIVISION <br /> S2.❑ �'tIh <br /> STRUCTURE/ADDITION USE: ra O 0 (1 t <br /> (Home/Cabin; Commercial Bud ness; Bedroom;Deck;etc.) (n YJ <br /> BUILDING CONTRACTOR: 6r <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'h X 11 SHEET OF PAPER. ANY INCOMPLETE OR m 3 r <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p " "11 <br /> a c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) Sl r C 0 Q C L,.\ <br /> r <br /> CL <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 'o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH IN). <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. I P <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. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS CN <br /> MUST BE SIGNED AND DATED BY THE OWNER. v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN <br /> 4 <br /> NEEDED. n <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o r <br /> CONDITIONS OF PERMIT: ^a <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT f Q <br /> ISSUANCE. p <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY qj <br /> PERMITTED. �1 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER X: <br /> SETBACK AREA. <br /> O <br /> 5. yy <br /> A M. S' , Q m�I M <br /> CL <br /> 6. m CN„ o 3 <br /> Z <br /> 7. ? ly m <br /> I declare that this application (including any accompanying schedule) h een examined by me and to the best of my c Q <br /> knowledge and belief it is true,correct and complete. I acknowledge t esponsible for the detail and accuracy of `: a` S <br /> all information contained in this application(including any accompIn nd I further declare that I recognize m m <br /> that this information I am providing will be relied upon by the Cou of B I sin in determining whether to is- O <br /> sue a permit. I further accept all liability which may I a result a County Ing on this Information I am m <br /> providing in this application. I agree to permit county officials rged w h adm i my ordinances or other CD <br /> o <br /> authorized person to h ccess to the above described premise at any4obnable t t urpose of inspection. m : <br /> ro <br /> c� _ &�% � 6'C �/ o � . <br /> SIGN HERE <br /> sign ur6 of owns r Iding contractor) O C ate) <br /> ZONING ADMINISTRATOR I` 40 40 40 40 40' <br /> f71(P <br /> V1 fl1 O ° N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0(J1 0N N 0 0 0 <br /> N N <br />