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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> CD APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> y <br /> C <br /> N <br /> OWNER rt £ TELEPHONE 7/C— ZaS _ ¢� O <br /> U m <br /> m <br /> MAILINGADDRESS 2 ?> 80 .,/� <br /> 00 ° <br /> PROPERTY ADDRESS Z S I <br /> LEGAL DESCRIPTION(see tax receipt) _ tS <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE I� ADDITION C <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING CAMPING UNIT ❑ SUBDIVISION ❑ �- <br /> STRUCTURE/ADDITION USE: r SNL a <br /> 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: C �rV$ l/C E. <br /> m <br /> v <br /> (D <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2X 11 SHEET OF PAPER. ANY INCOMPLETE OR � <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> O <br /> c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: AERIAL OR TOP VIEW) O � <br /> -n a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. Tf n � tz <br /> A <br /> 2 .SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS (EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THEFOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S)TO m I I� <br /> CENTERLINE OF ROAD,(C)BUILDING S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <br /> LAKE, STREAM OR RIVER AND MEAS REMENT TO WETLAND AREAS. Zo <br /> 4. SHOW THE LOCATION OF THE WELL( ),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO <br /> BUILDINGS, ROADS, LAKE, LOT LINE . <br /> 5. INDICATE IF A WALKOUT BASEMENT S PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTEI BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS I D <br /> MUST BE SIGNED AND DATED BY THI OWNER. Q) n 6 <br /> v <br /> f <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. 2 �' <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WI TH 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 ALTER TIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAIN NG WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 6. m m W M 0 0 n * m <br /> m D3am0, am ."0 <br /> 7. Z rn o E <o <br /> P m : -n'< : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my C <br /> knowledge and belief it is true, correct and omplete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognizem m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- W t7 <br /> 0 <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 � M o� ; o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other ° m `• <br /> authorized person to have access to the ab ve described sesat any reasonable time for the purpose of inspection. <br /> T a : <br /> SIGN HERE n <br /> t i <br /> $ yZ �� v+ Cl <br /> '(signof o er or building contractor) (d te) <br /> ZONING ADMINISTRATOR JI l7 �lJ`l' <br /> 1�: iniH <br /> amOV O0i- u;>� MOWWN) N <br /> N 0 O <br /> TOWN HIP PERMITS MAYBE REQUIRED <br /> THIS P MIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> -rer 1t: IPS <br />