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Burnett County 7410 Co. Rd. K„No. 102, Siren,WI 54872 Office of Zoning Administrator 0 o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> 0 <br /> y O <br /> N f" <br /> OWNER �7i�EE,u.S� G� .lwL.l +�RIA _�i2E^.•(-�L�+' �i TELEPHONE <br /> HOME <br /> HOME ADDRESSIZ�9t�trP4 ,��^ Y�Lk'X ��' Si/'trrr L2�S S-�rc � Z .. v <br /> r m <br /> EMERGENCY/FIRE NUMBER ¢ ROAD NAME wAL 11 CKj <br /> LEGAL DESCRIPTION(see tax receipt) S'JV/¢ .5E Y¢ <Ecp/_-A/ f¢ T Al � �' W (DT o <br /> e <br /> TYPE OF PERMIT(S): DWELLIN BU LDIN GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ c <br /> FILLING/GRADING ❑ CAMPING UNIT ElSUBDIVISION El CL <br /> STRUCTURE/ADDITION USE: o' <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) rn <br /> BUILDING CONTRACTOR: �FIr✓ ��t✓ i c'•' `sT�1��C77�^�v _>j�EN �f/-Z <br /> v <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. T - <br /> M <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p <br /> n 0. <br /> _n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m I <br /> NORTH(N). C n <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. o <br /> 4. SHOW THE LOCATION OF THE WELL(1N),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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN S <br /> NEEDED. 1 Q <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z -� <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. i <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY 1 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBAjK$REj/ � <br /> 5. S7`e 7/�Ui idl/ j'egcc�� Y�>�7c�ril� eN ��e <br /> 6. ck� 6 / 1 r <br /> 1 N4 <br /> — ti ? m <br /> I declare that this application (inclu ing any accWn <br /> nying ) amined by me ando <br /> hebest of my c p <br /> knowledge and belief it is true, co, ct and compI acknowledge I onsible for the detail and accuracy of a d C <br /> all information contained in this application(incluany a panying sch d further declare that I recognize m m ': . . m <br /> that this information I am providing will be relied by t u�ty�f rnett Wi onsin in determining whether to is- �' O <br /> sue a permit. I further accept all liability which mayA ,a result O t. of B n4tt relying on this information 1 am d <br /> providing in this application. I agree to permit couwlvl $charged ww�i In ad tering county ordinances or other m <br /> authorized person to have access to the above described pr isle y eason b e time for the purpose of inspection. -n <br /> N <br /> SIGN HERE � /�-ES/p / Gd ' ' <br /> (signature of owner o b in o r (date) <br /> ZONING ADMINISTRATOR 2 <br /> Vvifnf»v+fnEn� <br /> N N N N <br /> 5A (JipfT tTpp <br /> TOWN IP PERMITS MAY BE REQUIRED ( 0 0 0 0 0 0 0 <br />