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Burnett Z ounty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator �'d 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> y O <br /> m r <br /> // G cit <br /> OWNER Rd ber-j B koe I�e n TELEPHONE 7 73 2 67- -TV 111 v <br /> HOME ADDRESS g a UJ , SO-ST woo Cwc o ! Z- 606 2 s cplt <br /> M <br /> EMERGENCY/FIRE NUMBER ' L47 I ROAD NAME C"r-t%,/ <br /> LEGAL DESCRIPTION (see tax receipt) L o"t 1 .SSG-tron -29 /oW ns�-� W) No 4 Ran5 e t f W) <br /> 01 <br /> yr„epf�C�'e m <br /> � <br /> DWELLING/BUILDING 1:11 <br /> GARAGE/ACCESSORY STRUCTURE ❑ ADDITION �1 PRIVY El0(n = <br /> TYPE OF PERMIT(S): <br /> v <br /> FILLING/GRADING ❑ CAMPING UNLIT ❑ SUBDIVISION ❑ a <br /> S. <br /> STRUCTURE/ADDITION USE: C Alo/+-� / o.60ifpor� ocP 3 Sec-son Sc r•eer) Perch <br /> (Home/ abin; Commercial Business; Bedroom; Deck;etc.) m <br /> i� fi <br /> BUILDING CONTRACTOR: -Mo.0 P Son AC.Sonrv� , (uc rren Dcn ker S s oe SU Ls iv <br /> 7� L1 l M <br /> O er') P Hof e✓� n'fec�Cto <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 HEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O m <br /> z N G <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O Qin W <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). y o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <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. c <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. `2 <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 Q� <br /> MUST BE SIGNED AND DATED BY THE OWNER. o IW <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q S <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c V <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. <br /> 6. 64�[ <br /> ;o -0 O O � <br /> m . m n m <br /> 3 CL <br /> 6. � � B n m `t-7. -ae•� � <br /> oM <br /> Vic, : m <br /> I declare that this application (including any acco nying schheddu examined by me and to the best of my of c C <br /> knowledge and belief it is true,correct and complet I ac ge th risible for the detail and accuracy of m <br /> Q ' ' <br /> all information contained in this application(includ ac p}n <br /> Ing <br /> s d I further declare that I recognize m m m <br /> that this information I am providing will be relied upon a Co0nII&f�urns sin in determining whether to is- �s O <br /> sue a permit. I further accept all liability which may be a of the<zmty of relying on this information I am m <br /> providing in this application. I agree to permit county argednWith ad i tering county ordinances or other E m <br /> authorized person to have access to the above described p ny reaso time for the purpose of inspection. T <br /> SIGN HERE <br /> (signature f o ner or building contractor (date) <br /> ZONING ADMINISTRATORU01 w <br /> wwwwwm-• <br /> N Nn P N N)L" <br /> (T (l� O (Ji (n O P <br /> O <br /> TO NSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br /> 0000000 <br />