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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v 0 Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r (� <br /> rn <br /> OWNER TELEPHONE 6S/A-'-3S/ 0 <br /> o <br /> m <br /> HOME ADDRESS (0'7C� / Y/}�� F '� <br /> r m <br /> 0 <br /> EMERGENCY/FIRE NUMBER � e� ROAD NAME <br /> i <br /> LEGAL DESCRIPTION(see tax receipt) --O 7 J-00 d y <br /> [� m <br /> QW&L- IM6VBUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ ( N <br /> TYPE OF PERMIT(S): c <br /> c <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> 5. <br /> STRUCTURE/AO&4;P N USE: CA be 0 <br /> t (Fjom�/Cab*n�Commercial Business; Bedroom;-Deck;etc.) rn <br /> BUILDING CONTRACTOR: D ( � <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/]X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. n <br /> O r, <br /> in UJ <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) T a n p� <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m T <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 330 <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. 216 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 /> 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 O ` <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 WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> 0 <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT V <br /> ISSUANCE. t (T <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 (f`) <br /> SETBACK AREA. f <br /> 5. <br /> s a� mcNNo ' 3 <br /> g <br /> 7. 0 : y :il <br /> o : <br /> o' m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my a c 10 <br /> C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize �' m (D <br /> that this information I am providing will be relied upon by the County o consin in determining whether to is- p <br /> sue a permit. I further accept all liability which may be a result of the ai" <br /> on this information I am m <br /> providing in this application. I agree to permit county officials cha ' e i _Lprdinances or other m E <br /> authorized person to have access to the above described premises ny reasons f se of inspection. -, <br /> A m <br /> SIGN HERE AUs 2 9 <br /> gn l�ofer or building contractor) �� ( at <br /> ZONING ADMINISTRATOR RNE7? �. . . . . da <br /> NTNG <br /> N NCnNNfT UI <br /> fly (T O (J1 Ut O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />