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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 a <br /> CD <br /> / N ^ <br /> OWNER j p�er� P �,3S-s�3b a <br /> �Z' PO VVI � TELEPHONE <br /> I Q ` ULT;,1 ,q o <br /> HOME ADDRESS 1127 CT y 1�c+ ; e&�'� ULT; J v <br /> r m <br /> EMERGENCY/FIRE NUMBER (2-2,7 ROAD NAME K o <br /> LEGAL DESCRIPTION(see tax receipt 3. V/ Y00 7" Cf) <br /> ( n <br /> Q <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ d y <br /> TYPE OF PERMIT(S): Cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITION USE: (-f4fZ A &-L PO t 6 A l-b(' • 0 <br /> i ( ome/Cabin; Commercial Business; Bedroom; Deck;etc.) y <br /> BUILDING CONTRACTOR: <br /> 1 i <br /> 'a <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR n9. <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> x N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a Q <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m ;° <br /> NORTH(N). <br /> n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m a <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. VQo <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 1 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o f <br /> E? 9 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q o <br /> NEEDED. 2 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: o <br /> �i <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 91 <br /> ISSUANCE. W UJ ) <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. r,, <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY (�j O w <br /> PERMITTED. IIIMMM�///j <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> This structure to be used as private residential z 'D n r o o m <br /> d <br /> 6. garage/storage only. Not to be used for human C a 0.a ;a <br /> habitation. <br /> 7. o .'0 <br /> _ co : <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my (j ID <br /> knowledge and belief it is true,correct and complete. I acknow ge that I am responsible for the detail and accuracy ofCL <br /> m C <br /> all information contained in this application(including any accorq chedule)and I further declare that I recognize m <br /> that this information I am providing will be relied upon by the Co isconsin in determining whether to is- D <br /> sue a permit. I further accept all liability which may be a resr/If 4hi�' *,ng n this information 1 am providing in this application. I agree to permit county offici charge i 4,it'iry ordinances or other mauthorized person to h ve access to th ve described pr es at any reason e i erpose of inspection. m <br /> —10 0CDCD <br /> SIGN HERE <br /> ooi _v <br /> s t e of ownero wilding contrac (date) <br /> ZONING ADMINISTRATOR CC Co <br /> to to<n fn cn w <br /> N N (INNIIIN <br /> V7 NO Vt VtOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED a3U0b o O O O O O O <br /> 0000000 <br />