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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator CD' o 0 <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER (-kA TELEPHONE �7l S� c( (p -02 3 07 �X <br /> e.12$ <br /> MAILING ADDRESS (=P5304 <br /> 0 <br /> 0 <br /> PROPERTY ADDRESS <br /> P) a s�UL/ CD <br /> CD <br /> LEGAL DESCRIPTION(see tax receipt) <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION W <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING U I SUBDIVISION ❑ /� < <br /> STRUCTURE/ADDITION USE: //'1 Jlt i �C Ja-6�✓ F =. <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) /U/ U <br /> BUILDING CONTRACTOR:/ <br /> Z -4 <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/f X 11 SHEET OF PAPER. ANY INCOMPLETE OR n <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 n <br /> T o z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m� <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <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. ( ° <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. 1 I <br /> o <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. ° <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN �✓v <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: G <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. <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� � G <br /> SETBACK AREA. �— f� C/,( „ v`6 <br /> 5. ]f_- (vxrC/[//V/ 'n l'J(�/J CD W m 0 M Da f m <br /> V/ /(JC/• R 3 n � Ox M <br /> 6. �� _ <br /> � N C m fn Oic <br /> y y o O I <br /> 7. o T�2 m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m - �^ ' A <br /> PP ( 9 Y ) Y Y ,, , a <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of n 0 N <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o 0 <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information I am d <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. `° o <br /> CD69 <br /> m : <br /> SIGN HERE 2- U <br /> CL : <br /> (s na ure of owner or Iding ontractMor) �J (date) <br /> ZONING ADMINISTRATOR <br /> in fA EA EA N <br /> too NNOO <br /> /^1 GOON NOO <br /> TOWNSHIP PER ITS MAY BE REQUIRED / t/J7V1 <br />