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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator �- 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> o <br /> C <br /> d <br /> OWNER ` �� K� TELEPHONE '7 ' �-- L./a 5— 70 <br /> ' V <br /> HOMEADDRESS W �UJa—� +� Ave7�5 Q 1 <br /> 71 t t�Pr- 5o l tst w I -5 Uo as <br /> R <br /> EMERGENCY/FIRE NUMBER ':n Ur)-7(o ROAD NAME S a LA-) <br /> P61 <br /> �� <br /> C <br /> LEGAL DESCRIPTION(see tax receipt) -7— y� - S y <br /> m <br /> 1 a <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION PRIVY ❑ <br /> 0 <br /> TYPE OF PERMIT(S): v <br /> FILLING/GRADING ❑, CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> S. <br /> STRUCTURE/ADDITION USE: ` / S' exui gt� L-ea_t7 (6, u�✓, , <br /> c r (Home/Cabin; Commercial Bu ness; Bedroom; Deck;etc.) y <br /> BUILDING CONTRACTOR: S C' T Er <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/]X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. i7 m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <br /> n <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 <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 1 <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. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS �, <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> v � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN q <br /> NEEDED. a <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 PERMITJtC <br /> ISSUANCE. � v <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ( ) <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETK AR � <br /> 5. <br /> 0 m � , M <br /> O DQ v m <br /> 6. � 3 nm F?- <br /> a <br /> mcul"i `" os3 <br /> 7. Z N N _ <br /> 9 � <br /> ' <br /> o M <br /> y : m <br /> I declare that this application (including any accompanying schedule) hps bgeri xammed by me and to the best of my ; c p <br /> knowledge and belief it is true, correct and complete. I acknowledge that ploirm le for the detail and accuracy of m S <br /> all information contained in this application(including any accompanyi g scFie �' cfJ(ur(her declare that I recognize m P i m <br /> that this information I am providing will be relied upon by the County Burnett Wl�" sin i�I determining whether to is- [ O <br /> sue a permit. I further accept all liability which may be a result of thp'Coun BUrnetC0el rP' on this information I am iu ; <br /> , , � <br /> providing in this application. I agree to permit county officials charged wit isterin o ordinances or other m <br /> authorized perso have access to the above described premises ftLreasorialille QrW for the ' rpose of inspection. m <br /> CD <br /> i Frj p <br /> ,) C <br /> SIGN HERE > <br /> (signal of�pwnerorbuildin tractor) �,t,or,fA (date) <br /> IVU 'b <br /> ZONING ADMINISTRATOR �. . . . . . d, <br /> N+tN fN to to to <br /> N N N N N f l N <br /> to NO N Ln 00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0000000 <br />