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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS jj 4 ��� <br /> x553 (r /07 /�l 55�C1� <br /> �"� 1n! 2 (1 �1 fDM <br /> ' <br /> OWNER V�ra Ul TELEPHONE �� 0�7 �I 7 0 �. <br /> MAILING ADDRESS �y 3y �7'/ZErN �/d �c� Sppon/tY �tJ i Seal °� <br /> 0 <br /> PROPERTYADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) /V C S <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ 1 co ° <br /> TYPE OF PERMIT(S): n ' <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDR/ISION ❑ <br /> STRUCTURE/ADDITION USE: 10 ) S�c 4 A S t` SAiw d <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) cn <br /> m <br /> BUILDING CONTRACTOR: d' <br /> Z � <br /> m <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 /> O <br /> .'tl N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). C <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 9 <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. Q <br /> 6. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. IN <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 '�. <br /> v � ( <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATIQ II�G�ONE WHEN ° <br /> NEEDED. (/I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: I w <br /> JUL � <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF P <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINEURNETT Cp <br /> 3 NO GRADING <br /> ED. OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY ZON'NG UN1Y <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 6. 3 CLCD Fnm <br /> o m CN y o 3 <br /> 7. Z in m <br /> o T � m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of d0 sv <br /> a 0 : M <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o : m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m <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 d <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. `° o <br /> CD <br /> SIGN HERE 1 t I <br /> a : <br /> (signature of owner or buildin n rac r� (date) <br /> 10 <br /> ZONING ADMINISTRATOR <br /> EA fA fA fA� N <br /> (� N (TN NOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />