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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 71 o° o <br /> APPLICATION FOR LAND USE PERMITS 3. < <br /> r <br /> y O <br /> N <br /> OWNER D � fl �I-Q�f! TELEPHONE <br /> W <br /> MAILINGADDRESS g7� g" G �O ti O <br /> f1) <br /> PROPERTY ADDRESS �(, LJ � uil (�� 1 �.c��'�� 1 \ 1 <br /> LEGAL DESCRIPTION(see tax receipt) 11 r�� u� I O <br /> IV 1 m <br /> y <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION to C <br /> TYPE OF PERMIT(S): c <br /> Q <br /> FILLING/GRADING CAMPING UNIT ❑ SUBDIVISION ❑ <br /> / O 0 \ <br /> STRUCTURE/ADDITION USE: � �� �y"\ /��7L_I(p/ o' r <br /> ("Home/Cabin; Commercial Business; Bedroom; Deck; etc.) O � <br /> T <br /> BUILDING CONTRACTOR: �'2�-P't'so �J zzWLc� E; <br /> M <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 814 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> o y Q S <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING- (AERIAL OR TOP VIEW) O <br /> m n <br /> m z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n <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 J 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. �`' o <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO 1 CPBUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N U4 <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. o t <br /> O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN � <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> t <br /> CONDITIONS OF PERMIT: ] _ <br /> „ t <br /> O <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 3ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY d <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> M m 0 r DO D D -V <br /> m c W W n m W * m� <br /> 6. 0 > > n n 0, <br /> 'O Op W C y - 0 3 <br /> 7. Z C y ry O 7 O <br /> O m <br /> I declare that this <br /> application (including an accompanyingschedule has been examined b me and to the best of m - 2 O <br /> PP ( 9 Y ) Y Y <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m n ' N c <br /> all information contained in this application(including any accompanying schedule)and I further declare that1 recognize m c m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> G): <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this informationI am W : o <br /> providing in this application. I ag ee to permit county officials charged with administering county ordinances or other <br /> m <br /> authorized person to have access the above described premises at any reasonable time for the purpose of inspection. <br /> T <br /> n <br /> SIGN HERE n <br /> (signature of owner or 6uilding contractor) (date) <br /> ZONING ADMINISTRATOR <br /> �d163 fR fA�N <br /> O N N W W N O <br /> O U O N N T 0 <br /> TOWNSHIP PERMITS MAYBE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />