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6)vrqp <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> 04 eb-a�a a `7 0 <br /> el <br /> ` <br /> OWNER �'wC s--U,r-�t�� TELEPHONEOM <br /> t�3S <br /> HOME ADDRESS <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) Tyo N (� I y w Jon <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION PRIVY ❑ on <br /> TYPE OF PERMIT(S): rr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> Fn <br /> STRUCTURE/ADDITION USE: hinv _ Rn ek" 0 <br /> (Home/Cabin; Commercial Business; Bedroom; DecV-,etc.) on <br /> /J o <br /> BUILDING CONTRACTOR: I,C� ( 'drtc�-ruG�a-�_ 5r r — � <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN B'/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> 0 � cG <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 00 a <br /> T o Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m 75 A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). y <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. I P <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. J <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. 'c <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHENq 0 _ <br /> NEEDED. �» <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o i <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. <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. .c, b y� <br /> lya <br /> 6. " s_ CODrCO <br /> 7. 1Qh PIS nr w ) 1 �C c N Q <br /> w CMDrn <br /> I declare that this ap ication (inclu ing any accompanying schedule) has been examined by me and to the best of my c C <br /> knowledge and belief it is true, correct and complete. I acknowI d e�thaEt' 1, responsible for the detail and accuracy of c <br /> all information contained in this application(including any acco nyiA�s le)and I further declare that I recognize m m <br /> that this information I am providing will be relied upon by the C my of ne sconsin in determining whether to is- d O <br /> sue a permit. I further accept all liability which may be a result`of the Cou .ett relying on this information I am m <br /> providing in this application. I agree to permit county officialschar with �tI t@ring county ordinances or other m <br /> authorized person to have access to the ove described pre ata easoh e e for the purpose of inspection. -n <br /> m <br /> SIGN HERE <br /> (sig ure o wn o ding contr (date) <br /> ZONING ADMINISTRATOR d+ <br /> to to v+<n fn cn <br /> N N(T NN (n c) <br /> ' Vt Vt O G1 V7 O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED ay3(� o 0 o 0 0 0 <br /> 0000000 <br />