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Burnett County 7410 Co. Rd. K, No.102,Siren,WI 54872 Office of Zoning Administrator T c o <br /> APPLICATION FOR LAND USE PERMITS <br /> r <br /> CL <br /> N o <br /> OWNER Le(��� TELEPHONE �s/ �4y0'171 S — w_ <br /> MAILING ADDRESSS�OrV// <br /> eeW nlilih <br /> O <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) �t cs V 6:v I/ <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION. (/> <br /> TYPE OFPERMIT(S): FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ I-��, � a <br /> STRUCTURE/ADDITION USE: <br /> (Home/ abin;Commercial Business; Bedroom; Deck;etc.) sn <br /> BUILDING CONTRACTOR: f� m <br /> v <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR m <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> (yA <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a <br /> ?t o z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m a <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). N o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF 1 Z <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 /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. Iv n ` <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS w <br /> MUST BE SIGNED AND DATED BY THE OWNER. F <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN y <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o I <br /> CONDITIONS OF PERMIT: <br /> t. 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 /> 5. <br /> 9 11 0 IDM 111 <br /> 6. m 3 nm yam <br /> 'O m C:W <br /> 7. o N m 301 <br /> m <br /> 1 declare that this application (including an accompanyingschedule has been examined b me and to the best of m ^ : A <br /> PP (� 9 Y ) Y Y L7� <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of w C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m E m <br /> that this information I am providing will be relied upon by the County of B tt sin in determining g whether to is- <br /> sue a permit. I further accept all liability which may be a result of the r� thio information 1 am �E E m : E� <br /> providing in this application. I agree to permit county officials char <br /> � � dmagees or other <br /> authorized person to have access to the above described premises at reason I r e o)se o Inspection. -n m c <br /> CD E m <br /> SIGN HERE OF» E <br /> (signat owner or building contractor) r( ate) <br /> CL : <br /> ZONING ADMINISTRATOR i BURNETT COUNTYo ' <br /> �m a/j ZONING N o <br /> V7 O O <br /> TOWNSHIP MIT MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE „` <br />