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Burnett County 7410 Co.Rd. K,No.102,Siren,W154872 Office of Zoning Administrator -0 c o <br /> APPLICATION FOR LAND USE PERMITS <br /> N � " <br /> (D <br /> 1 <br /> / <br /> OWNER a 4/t TELEPHONE 715 (553 _3 /)0!5� v r <br /> m <br /> MAILING ADDRESS pQ �x :23 <br /> PROPERTY ADDRESS AI <br /> ( s�y <br /> r <br /> LEGAL DESCRIPTION(see tax receipt) S �L� ���� -T3 <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ to <br /> o `� <br /> TYPE OFPERMIT(S): n (� <br /> FILLI G/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITION S ° <br /> cc p (Home/Cabin;Commercial Business; Bedroom; Deck; etc.) m <br /> BUILDING CONTRACTOR: <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> � c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a <br /> ?I 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 <br /> C � 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. I P <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. t 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. m f <br /> v � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN g <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o O <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. C-'N� <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 REQUIREDWATER <br /> SETBACK AREA.-I f , <br /> I' ncr-� bei (.CSCE rt),— huink l�hita `� <br /> m m m 0 A F <br /> ° 3 am m <br /> 6. m <br /> t?(1 (� a m yC y <br /> o : <br /> 7. o n < <br /> I declare that this application (including any accompanying schedule)has been examined by me and to the best of my G)c C <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of w o E en <br /> a•• : M <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o C <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 Cou f tEnformation I am w <br /> providing in this application. I agree to permit county officials charge i ia(iCes or other w toauthorized erso h access to the above scribed premises at i PC of inspection. -n l c , <br /> i m ; m : <br /> SIGN HERECL <br /> actor)(signature of o or building contra ' . <br /> ZONING ADMINISTRATORa' y) <br /> lla,�Iaaa f <br /> 8 <br /> -i3URNE IT r, : : <br /> o <br /> 7 <br /> TOWNSHIP PERMITS MAY BE REQUIRELTOIVING N <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />