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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - °CD oo <br /> APPLICATION FOR LAND USE PERMITS . <br /> 5T 0 <br /> OWNER TELEPHONE S , ;� I <br /> d <br /> MAILING ADDRESS S P <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) I/ — �� \ <br /> S-eN <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION o <br /> TYPE OF PERMIT(S): I� <br /> FILLING/G A^DING ❑ CAMPING UNIT ❑ SUBDIV ION, n <br /> (31� CS \\1 < <br /> Lei�e <br /> STRUCTURE/ADDITION USE: ICfM o <br /> (Home/Cabin; Commercial Busines Bedroom; Deck; etc.) Cn <br /> BUILDING CONTRACTOR: D� ► (Z tom[ �V CPY1S m <br /> m <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> W <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n A <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 m3D <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 <br /> BUILDINGS, ROADS, LAKE, LOT LINES. I Its <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. �/\ o d <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS t 0 ) <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. <br /> 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o a <br /> CONDITIONS OF PERMIT: SLS <br /> i <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. b <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 <br /> SETBACK AREA. <br /> 5. <br /> CD )0 a0Qov <br /> 6. m i'c 3 c, 0, � <br /> 7. Z c w m o <br /> P m -n' ' 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 �E E C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m �_ <br /> all information contained in this application (including any accompanying schedule)and 1 further declare that I recognize CD m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is,-_ D rn <br /> sue a permit. I further accept all liability which may be a result of the County of Bur formation I am d o <br /> a ' <br /> providing in this app' on. I agree to permit county officials char 1 nces or other m `D <br /> (D <br /> authorized person t hav o <br /> access to the ve des ribed premises I fFha5s of inspection. a <br /> T <br /> D i <br /> SIGN HERE 1' a E <br /> (signature o caner or building contra r) AU Q 5 ate o <br /> • H — r& 000 � mo <br /> ZONING ADMINISTRATOR RN�� .p��7lNG � I f/Jcc,TOWNSHIP PERMITS MAY BE REQUIRE* <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />