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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v c1 ��z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> UT 0 <br /> OWNER ) ` ryIs �- tc/? - Q-29'-1:3 <br /> C u i S aJ C (t✓L SC) TELE „ n <br /> HOME ADDRESS IF W; ti4 F S d [S rn a 57SY�0 <br /> � l f <br /> EMERGENCY/FIRE NUMBER a7 ROAD NAME—7—C)CL)0 _�(� <br /> LEGAL DESCRIPTION(see tax receipt)13a'674--r- <br /> TYPE OF PERMIT(S): DWELLING/BUILDING 1:1 GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ c �' <br /> FILLING/GRADING 1:1CAMPING UNIT ❑ SUBDIVISION Eln <br /> STRUCTURE/ADDITION USE: 12o <br /> Home/Cabin; Commercial Business; Bedroom; Deck;etc.) T <br /> BUILDING CONTRACTOR: 13RUCE <br /> C <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m0 3 <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) /;O <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T z <br /> n � <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m :b <br /> NORTH(N). C 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 333 <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. z <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO O <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. o <br /> f <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z <br /> CONDITIONS OF PERMIT: <br /> I <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. f <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 /> This structure to be used as private residential n r p o D v v <br /> 6. garage/storage only. Not to be used for human 3 a S g _a CD z <br /> p N N ^ _ <br /> 7. habitation. - 0 o : 3 <br /> Z <br /> o ii'� : ;a <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my �j C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of a 2 <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize CD m <br /> that this information I am providing will be relied upon by the County of u in determining whether to isCD <br /> - <br /> sue a permit. I further accept all liability which may be a result of the Coo n <br /> ation I am <br /> providing in this application. I agree to permit county officials charge 1 rMn or other <br /> authorized person to have access to the above described premises at an r asonable timeu spection. fD <br /> T <br /> CD t <br /> SIGN HERE APR 0 <br /> signature of <br /> 0 j ner or building contractor) (da <br /> ZONING ADMINISTRAT ) IG�I l 13URNETT GOU <br /> NTy <br /> ZUIVING <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />