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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Admin stror <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> 0 <br /> N <br /> N <br /> OWNERf''.4-� �. �IsJE':'� L-I ISo.�.__ TELEPHONE � — �ZZ v \' <br /> HOME ADDRESS �-) 64k �, 1JI, E. 2,57 00(()ia64 _ <br /> _ m <br /> EMERGENCY/FIRE NUMBER 3 6D ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) L �•+ Z• s>,P 1 — ki 0 (t� O� CO <br /> 1 � <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITIONPRIVY ❑ u) a <br /> TYPE OF PERMIT(S): c o <br /> CL <br /> FILLING/GRADING ❑ CAMPING UNIT E] ❑SUBDIVISIO,I S <br /> SE <br /> STRUCTURE/ADDITION USE: t_ _- 6 —" �� �f0►"Ll 0 <br /> (HHoo-me/Cabin;nCommercial Business; Bedroo ; Deck;etc.) rn <br /> BUILDING CONTRACTOR: I I.0"fs C nnSG' ti— iv <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR .n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a <br /> _ O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C 9 <br /> n <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 IM <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF I Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO b <br /> BUILDINGS,ROADS,LAKE,LOT LINES. I <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N 1 <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. 'o o <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN _q <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. dV <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 /> �� -�� �- <br /> 5. 4 bu Caa /t-ti �'� O x v0 r. o o v <br /> .17 <br /> =Cr : : m <br /> I declare that this application (including any accompanying has been examined by me and to the best of my Cr C <br /> knowledge and belief it is true,correct and complete. I a e esponsible for the detail and accuracy of o <br /> all information contained in this application(including a acc I I I further declare that I recognize m m : m <br /> that this information I am providing will be relied upon b the County b s n in determining whether to is- <br /> sue <br /> s sue a permit. I further accept all liability which bA result C un ty o Ing on this information I am <br /> providing in this application. I agree to pe county ficial i aSinis county ordinances or other m <br /> authorized person to have access to th ve scribe I' tl rthe purpose of inspection. T <br /> SIGN HERE © 2 e <br /> (s atur f owner or b 'ding cont o � !'�� (date) <br /> ZONING ADMINISTRATOR d+ <br /> cnwwcn f»ui� <br /> ]7�� <br /> .1�� `•t i . N V1 O Vt N O O <br /> TOWNSHIP PERMITS MAY BEQUIUi�ED 1�qq' v 66666660000000 <br /> /UO 6Q- tusse� <br />