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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning AdministrBtOf <br /> APPLICATION FOR LAND USE PERMITS y N <br /> II TELEPHONE �(��(o�� 'ZOp� o - J <br /> OWNER V O <br /> �24tv '1Ltf--g,F � IMP�� Mw l� z <br /> MAILING ADDRESS r � tib `D <br /> PROPERTY ADDRESSCn <br /> 3 <br /> LEGAL DESCRIPTION(see tax receipt) 2 ,- <br /> � o <br /> DWELLINGIBUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION <br /> C <br /> TYPE OF PERMIT(S): <br /> FILLINGIGRADING ElCAMPING UNIT ❑ SUBDIVISION ❑ �, �, <br /> o <br /> 0 <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDINGCONTRACTOR <br /> d � 3 <br /> m <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 0 3 (;p <br /> O N <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. ;0 <br /> O a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) -n <br /> T a Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> (� v J 17 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C 3 <br /> NORTH(N). m -P <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO <br /> CENTERLINE OF ROAD,(R AND MEASUREMENT MEAS TO WETLAND AREAS.ORDHIGH WATER MARK(OHWM)OF o <br /> LAKE,STREAM OR RIVE Q <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO U.1 <br /> BUILDINGS, ROADS, LAKE,LOT LINES. N <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. o <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR,ETC.,THE PLANS =. o <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. <br /> Z c' ` <br /> o <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> U <br /> CONDITIONS OF PERMIT: " <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT d <br /> ISSUANCE. <br /> OF TREES AND ARE <br /> \ Q <br /> 2. REMOVAL OR CUTTING 3. NO GRADING OR SHORELAND ALTERATIONS AREOALLOWED UNLESS SPECIFICALLY N IS RESTRICTEALONG RLINE. <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. w 0 M n M aa : m <br /> CD F3am0LLcT W <br /> ° m Tom : m <br /> 7. — ifl A <br /> Jj c, s N <br /> I declare that this application (including any accomte. I acknowledge that <br /> schedule) has been examined by me and to the best of my � <br /> _ d � <br /> [ C i m <br /> knowledge and belief it is true,correct and complehat I am responsible for the detail and accuracy ze ©; ID <br /> O <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- v ; o <br /> sue a permit. I further accept all liabilit ich may be a result of the County of Burnett rel in on this information I am <br /> providing in this application. I agree o county officials charged with admonabl is i <br /> r d <br /> authorized person to have access tot e a o ascribed premises at any reasonabl h > : <br /> m a : <br /> SIGN HERE ( e o . <br /> (s lure of own r uilding contractor) APR <br /> PO <br /> O WT WP <br /> ZONING ADMINISTRATOR BU ((�� ^� <br /> V ON CO <br /> TOWNSHIP PERMITS MAY BE REQUIRED ZONING <br /> THIS PERMIT SHALL EXPIRE ONE YEAR <br /> 6LF I Le- Ev J-6 h n SNI <br />