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�i�rmyn <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> iT0 <br /> N <br /> CD <br /> OWNER TELEPHONE <br /> HOME ADDRESS 'V1�/ 124E& TR/4/4i <br /> EMERGENCY/FIRE NUMBER /96 C/ ROAD NAME <br /> �Siy U3 p�br' nvCavr coT 3-' � <br /> LEGAL DESCRIPTION(see tax receipt) S/ ? /�/yW /, al 1 <br /> 7S' �'3`JCn <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE KADDITION ❑ PRIVY ❑ D AG e <br /> �{ a o <br /> TYPE OF PERMIT(S): v <br /> Cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> N <br /> ��^^ <br /> STRUCTURE/ADDITION USE: L e-L e4o 0 <br /> " ::-- U) <br /> (Home/Cabin; Commercial Business; Bedroom; Dec)etc.) <br /> BUILDING CONTRACTOR: /,—�A/'LF ,(JD,p-b /d w,{i,c �t J,�S�j,y� . <br /> v <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 n <br /> O <br /> it N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 CN <br /> m o- <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. o <br /> zA <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m 9 <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 1111 <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. 1 0 <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. 00 Q <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N X� <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. c <br /> o 9 <br /> NEEDED. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a o <br /> 2 t� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: tQ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT i <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. lF <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQ(UIIIREDJ VAT/ESR <br /> 5. <br /> SETBACK ARE <br /> CD 0 <br /> CD m <br /> 7. 1 ' <br /> 2 : m o m i <br /> o ? zil'< : ; ;a= cnm <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of 'm C <br /> all information contained in this application(including any accompanyi hedule)and I further declare that I recognize m m <br /> that this information I am providing will be relied upon by the County V opsin in determining whether to is- E O <br /> sue a permit. I further accept all liability which may be a result of td tett on this information I am ; m' <br /> providing in this application. I agree to permit county officials t ged wi r ?t#y ordinances or otherCo <br /> authorized person to have access to the above described premis t any reasonab e a pose of inspection, m <br /> 0 5ti CD <br /> nCD <br /> SIGN HERE r Sft <br /> OOD <br /> (sig lureabcaner or building co r tor) RN (date) <br /> ZONING ADMINISTRATOR /Y CO OVf� <br /> to vi cn cn En to <br /> N N VI NNN(T <br /> q VI V7 O Ut Ut O O <br /> WNSHIP PERMITS MAY BE REQUIRED <br />