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Zs <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 O fice of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. w <br /> r <br /> rn o <br /> M <br /> c <br /> m <br /> OWE ,I/��/� TELEPHONES _ L��p- {8�`3 a <br /> �1 Y , v v <br /> HOME ADDRESS 9 7 7 Q mw <br /> �S'�8,� 0 <br /> EMERGENCY/FIRE NUMBER 309 '7 ROAD NAME e:f4 yeN .6 <br /> 1 <br /> LEGAL DESCRIPTION (see tax receipt) C/ /V,! 3�—�$- /q m <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION El PRIVY ❑ o <br /> TYPE OF PERMIT(S): Cr <br /> a � <br /> FILLING/GRADING El CAMPING UNIT ❑ SUBDIVISION ❑ < <br /> o -M. <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) to <br /> m <br /> BUILDING CONTRACTOR: <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. O w <br /> En <br /> 0 r_ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) <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 rn <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. 9 <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. f <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 Q <br /> MUST BE SIGNED AND DATED BY THE OWNER. t o <br /> v � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN r 0 <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. <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 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> ;ov c� r v v � <br /> 6. CD <br /> rn '< 3 am xa <br /> ID C fy/1 y 0 7 3 <br /> u, m <br /> I declare that this application (including any accompanying sched b en examined by me and to the best of my c !a <br /> knowledge and belief it is true, correct and complete. I acknowfe ponsible for the detail and accuracy of c _C <br /> M <br /> all information contained in this application(including any ac o anyi�tgl cue end I further declare that I recognize CD m ; �� m <br /> that this information I am providing will be relied upon by the' unty of BuT(i IsCO in in determining whether to is- 0 <br /> sue a permit. I further accept all liability which may be a res of the __unty o n g on this information I am d <br /> providing in this application. I agree to permit county officials char gf ith admi i t n ty ordinances or other rn <br /> authorized person to have access to the above described pre at an'yffr oOable tim t p rpose of inspection. T <br /> M . i <br /> SIGN HERE <br /> 47 <br /> (signatu f owne ilding co or L (date) <br /> ZONING ADMINISTRATOR <br /> E»O Cn v+vi bn NJtNNCT c <br /> 1: �. NOC C> 0 O <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 00000 0 0 0 <br /> S � <br />