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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 � rr Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> o Arr 6A4pde4 C' <br /> 1 C . M � <br /> OWNER �LLLIN c�efrS `aliltlla/ I ��I�j TELEPHONE �r♦o�I� / ^ D7'17 0 a <br /> HOME ADDRESS D, 2 O <br /> 1t r .� <br /> EMERGENCY/FIRE NUMBER �9t b$ ROAD NAME I0 <br /> 1 <br /> ` <br /> LEGAL DESCRIPTION(see tax receipt) f O '�8 Q6 60 1.6t ( in <br /> TYPE OF PERMIT(S): DWELLING/BUILDING 1:1GARAGE/ACCESSORY STRUCTURE K] ADDITION ElPRIVY El c0 <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: I U eyO fTa� �A r.-el a S't Ara j& <br /> (Home/Cabin; Commercial Business; Bedroom,Deck;etc.) m ' (\ <br /> m <br /> BUILDING CONTRACTOR: �C���_f X591 n G O �G <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR � <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 'n 3 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: N(AERIAL OR TOP VIEW) O <br /> m a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. Z <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 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 t <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. e <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. Q <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N SL <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS Q <br /> MUST BE SIGNED AND DATED BY THE OWNER. c I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFIq <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z Q <br /> CONDITIONS OF PERM]T: N I _ J <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS O ERMIT J �. <br /> ISSUANCE. BUR NETT COUN <br /> 2, REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE TY SL <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY ZONING OQ <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 6. X � d; a?0 -U <br /> 3 <br /> 0, a <br /> .o �c' r. X! <br /> 7. Z : <br /> O x <br /> =yE ? i m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of ' m 9 : C <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize \ m m m <br /> that this information I am providing will be relied upon by the County of I ng whether to is- p <br /> sue a permit. I further accept all liability which may be a result of the Co u I i ptifortnation I am <br /> m <br /> providing in this application. I agree to permit county officials charg i u nances or other <br /> authorized persCD <br /> 7toha access to the above described premises at a y reasonable time for the purp a of inspection. mAYSIGN HERE .. '^ <br /> (signature of ow r or building contractor) ate) X <br /> ZONING ADMINISTRATOR BURNETT COUNTY <br /> N N U 1 N(T N <br /> V1 GO Vt 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 0 C)o i?0 <br />