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o'U "� <br /> Burnett County_7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o° o <br /> CD APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> N O <br /> N <br /> OWNER TELEPHONE o. <br /> HOMEADDRESS 114'13 <br /> EMERGENCY/FIRE NUMBER ROAD NAME SOP,�P,117 t -' <br /> LEGAL DESCRIPTION(see tax receipt) r\,m 1*� C,or ko V n�� 3lop <br /> Cn❑ <br /> DWELLING/BUILDIN GARAGE/ACCESSORY STRUCTURE� ADDITION ❑ PRIVY N o <br /> c 1e <br /> TYPE OF PERMIT(S): - n <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ y, <br /> STRUCTURE/ADDITION USE: 4: a4-b I itlt7ll 1' o <br /> (HomeF�bin; Commerci siness; Bedro m; Deck;etc.) C <br /> BUILDING CONTRACTOR: 0%.)Yee , 10 <br /> 6 _� <br /> 1 <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR ,n <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> .'0 y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) c <br /> CD <br /> Tn v z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m p <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. <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 su <br /> MUST BE SIGNED AND DATED BY THE OWNER. 0 \ <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHENCt ° _— <br /> NEEDED. <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 PERMIT ) <br /> ISSUANCE. p <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. GI <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 -V0'r- Dvv <br /> m . m , m F m <br /> 6. 0vammer- <br /> dA <br /> v m c m . o 3 <br /> 7. z !' :ii ° -1 <br /> o .'0 <br /> -m : m <br /> I declare that this application (including any accompanying ch¢ has been examined by me and to the best of my L7 ID <br /> knowledge and belief it is true,correct and complete. I a eit at Tam responsible for the detail and accuracy of o B ? E <br /> all information contained in this application(including an ac \s9he ute and I further declare that 1 recognize m m <br /> that this information I am providing will be relied upon, the County I�r�eI sconsin in determining whether to is- ' v <br /> sue a permit. I further accept all liability which may be, result QQ����ff��a County t"tt relying on this information I am m <br /> providing in this application. I agree to permit county.-�fficiaMs+ p7g d ith adminiering county ordinances or other m E <br /> authorized person to have access to the above describe remises at Iny ble ti for the purpose of inspection. m <br /> m : <br /> N���7 ' <br /> SIGN HERE 1 <br /> C dr . <br /> (signal e OC <br /> ner or building N date) <br /> ZONING ADMINISTR OR <br /> Fnv+w+»tntn� <br /> N N (IiNN VI (J, <br /> •� Vt ut O Cn tT 0 0 <br /> TO NSHIP PERMITS MAY BE REQUIRED �a 199 0 0 0 0 0 0 0 <br />