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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v ci Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> 0 (� <br /> /� 'j � / <br /> OWNER /`C E-i�'NET/i' /7EsL'�C� /C� SC7/� TELEPHONE <br /> HOME ADDRESS "NN ST R,l ,1A(,o? SVT S y�j �n =" 900 <br /> r m <br /> EMERGENCY/FIRE NUMBER; ROAD NAME V N S T AA t <br /> LEGAL DESCRIPTION(see tax receipt) (1 0 � �R�C� ?t <br /> 3 3 Y{ lcu Zoe--e /8 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION X PRIVY ❑ o <br /> TYPE OF PERMIT(S): <br /> FILLING/GRAD G ❑ CAMPING UNIT ❑ SUBDIVISION ❑ o. <br /> 5. <br /> STRUCTURE/ADDITION USE: o <br /> 0 <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: l A rr1 .S {� ��i ( v F�2 Sa�� c r i n <br /> firCD <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN fiY:X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n 3 <br /> Xt m <br /> DIRECTIONS FOR PLOT PLAN DRAWIN • (AERIAL OR TOP VIEW) <br /> e <br /> p <br /> -n a J <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. Z <br /> � <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> M ^� <br /> NORTH(N). C <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m a <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. o <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 /> 6. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <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. 5 e 0 <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN q o <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. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE, <br /> 3 NO GR <br /> TDING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. oKISM <br /> n. f) r <br /> o N d (D <br /> N m <br /> 6. -0 m C m y 0 3 <br /> 7. S �c Z ' N SD <br /> 0 <br /> Vim: m <br /> )Rr—I declare that this application (including any accompanying dule) h i bK me and to the best of my <br /> knowledge and belief it is true,correct and complete. I ackn dge that I am res n ' le,Iiir he detail and accuracy of m ' '• C <br /> all information contained in this application(including any ac panyi��edule)and I fuer her declare that I recognize CD <br /> C m E m <br /> that this information 1 am providing will be relied upon by the unty n ett 9i m in ermining whether to is- W p <br /> sue a permit. I further accept all liability which may be a result}}������ County of Brrelyin o this information I am W: y <br /> providing in this application. I agree to permit county officials dministering q&jrIty ordinances or other <br /> authorized person to have access to the above described premises at ary` "mworqhe purpose of inspection. - <br /> .mar;',,. �� �!c-nom_ NC' �D <br /> SIGN HERE �.�. � 1.�. �--. �� <br /> (signature f owner or building c tr ctor) (date) (��) <br /> ZONING ADMINISTRATOR <br /> t»wtn to to tn� <br /> WNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />