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C7i <br /> Burnett Cour'ty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> ' - r <br /> n O <br /> �t 933 6 <br /> Q j >Ss <br /> � 417y YSz7 <br /> �0OWNER °m <br /> OHOME ADDRESS 4!F50 I <br /> 9 <br /> EMERGENCY/FIRE NUMBER ROAD NAME .27 A <br /> &4� <br /> LEGAL DESCRIPTION (see tax receipt) V v Sts L7/ 1 y <br /> Ld- • (y 0 <br /> DWELLING/BUILDING A GE/ACCESSORY STRUCTURE ❑ ADDITI N ❑ PRIVY ❑ r4�J� y <br /> TYPE OF PERMIT(S): C <br /> o- <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITION USE: 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) Cl) <br /> BUILDING CONTRACTOR: E <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. n - <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O (D <br /> T O <br /> TZ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 m � <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m Q <br /> NORTH(N). C n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLANDL <br /> AREAS. �. ? <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. w, <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS I O <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> o SJ <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN 0 ob <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: A� sY" t1' ?G� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT �,y ^ 0 R� <br /> ISSUANCE. Uj <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ..� <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY (� I <br /> PERMITTED. p� <br /> 4. NO STRUCTURES, INCLUDING RETAINING r.- -0WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER/� <br /> SETBACK AREA. ,L .� tea( �/ I'lr..w+�r <br /> 1r�rr , <br /> 5. <br /> 6. <br /> I a....il <br /> ^�t•!-�1y ✓! /Lt<w/ � i� �-4.Jt.t.. L7'RA-!".I�' a �-- .�1 vM. c7 � o�O <br /> art.% LJt • arm+-c..'�„ t�-i 1 C : N C N y O Ocni ;a <br /> 3 <br /> - q <br /> c m <br /> I declare that this application (rn ding any accom anyin sc dule) has ben examined by me and to the best of my Lj C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of o E <br /> all information contained in this application(including any accomp ng schedule)and I further declare that I recognize m <br /> that this information I am providing will be relied upon by the C onsin in determining whether to is- O <br /> sue a permit. I further accept all liability which may be a result atTe <br /> ng on this information I am m <br /> providing in this application. I agree to permit county officials har my ordinances or other m <br /> authorized person to have access to the above described pre, i s at any rear h purpose of inspection. n <br /> Arts ID <br /> I <br /> SIGN HERE <br /> (signal re of o ner or buildin co frac Up^' ( ate) <br /> ZONING ADMINISTRATOR rl COU, . . . • • . . �n <br /> G �40��694040, <br /> N N(n N N (N un <br /> Ut u•O En N 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />