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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v G) Z <br /> APPLICATION FOR LAND USE PERMITS 3° <br /> r <br /> OWNER TELEPHONE JS,Z - 9'¢3• �g8/ Vj\1 <br /> v <br /> HOME ADDRESS //983 alof7ee, o*x P APO. LADE.✓�?ir/liter /l7it/ SS,3q)' o <br /> EMERGENCY/FIRE NUMBER 2 7 '99 7 <br /> ROAD NAME L o.vc" �owp <br /> q P �� <br /> LEGAL DESCRIPTION (see tax receipt) 07 .z cn.S� �/JrPS 9 (/�bor 1•,1� Cp <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION PRN;❑ ` q o <br /> TYPE OF PERMIT(S): 0 <br /> I a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ < <br /> STRUCTURE/ADDITION USE: Cif o <br /> // (Home/Cabin; Commmerr-ciahBdsiness; Bedroom; Deck;etc.) m �• <br /> BUILDING CONTRACTOR: Z11 l 6eX CO Al rY-1Z bio w/ '- <br /> in <br /> 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. -n - <br /> O <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) ;UO `m <br /> n a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. Tv n Z <br /> A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <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 <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. ` 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 /> 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 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. a <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN T o <br /> NEEDED. <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. o , <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ®r <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 /> SETBACK AREA. <br /> 5. <br /> ;a -U 0Wr > 0 > 0 -0 <br /> 6. CD m m 0 m a F m <br /> M <br /> I declare that this application (including any accompa sc I examined by me and to the best of my A <br /> knowledge and belief it is true, correct and complete. nowled r sible for the detail and accuracy of 0 m <br /> all information contained in this application(includi acco�panyin a further declare that I recognize <br /> that this information I am providing will be relied upon the of Burnet I determining whether to is- CD <br /> O <br /> sue a permit. I further accept all liability which may be suit of e n of B 9 t ng on this information I am ' <br /> ��+yJ . <br /> providing in this application. I agree to permit county charc44v' y ir)agge5°Or her 0 <br /> authorized person to have access to the above described pre any rea I urp o p c i n. m <br /> O O ID <br /> C : <br /> SIGN HERE �-ZB-O� <br /> (si at a owne b ' Ing contractor) MAY r <br /> ZONING ADMINISTRATOR 1 <br /> BURNETT COUNTY <br /> TOWNSHIP PERMITS MAY BE REQUIRED ZONING '�" <br />