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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> ;7 o <br /> N <br /> OWNER RRY anntF l�TR��-(LO TELEPHONE <br /> HOME ADDRESS N01 C:20 7 �(�� �� Rh e s( PP' /I[N -tk <br /> ll <br /> 5S9a b <br /> EMERGENCY/FIRE NUMBER ROAD NAME ��PS R8 d cY <br /> LEGAL DESCRIPTION(see tax receipt) 61 <br /> Lor j a 4 — `t v l(� m <br /> `( m <br /> c <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ CO O <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ 5 <br /> STRUCTURE/ADDITION USE: 0 <br /> (Home/Cabin;; Commercial Business; Bedroom; Deck; etc.) m <br /> BUILDING CONTRACTOR: �A L.L-V J ot/S 0 G R 4^)-rS OUR&Or sr <br /> '71-5— Wo-3— 5g9(a <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. � _1 = <br /> Cs N � fi .P N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) - `y O Q GU C <br /> n o Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C) m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). y 3 <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 Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 9 <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. Lyj <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN1 <br /> Cr ° <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. C <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. 6r.. ltd L�/ t 1 u, ��V lf� ;av0r � o�OV <br /> • d ; c m <br /> )'off 3nmOx <br /> 6. V fD Cin y 0 �_ <br /> Z a 7(p q <br /> 7. o A <br /> = cn : m <br /> 1 declare that this application (including any accompanying sche has a ined by me and to the best of my C <br /> knowledge and belief it is true, correct and complete. I acknowle that I am Is for the detail and accuracy of ! n <br /> all information contained in this application(including any accom anyin hed n rther declare that I recognize ' (D m m <br /> that this information I am providing will be relied upon by the Cof tt Wi i determining whether to is- m l7 <br /> sue a permit. I further accept all liability which may be a result o t our Qi Burn tt on this information I am m <br /> providing in this application. I agree to permit county officials chawith'•ad�iniste ' ty ordinances or other m <br /> authorized person to have access to the above described premises as I a urpose of inspection. CO <br /> m <br /> C" CD <br /> SIGN HERE <br /> sf atu of own r r building contractor) (date) 1 <br /> ZONING ADMINISTRATOR } 1 . . . . . �+ <br /> N N (T N N U 1 N <br /> VI 01 O [T (TOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br /> 0000 0 00 <br />