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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -U G) Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> ` y O <br /> OWNER TELEPHONE <br /> 1 V 1/4s/ `-+ <br /> MAILINGADDRESS O <br /> _r f <br /> PROPERTYADDRESS <br /> .Sec fon a5' IW39 R � ' <br /> LEGAL DESCRIPTION(see tax receipt) O CS IS CLt. O O <br /> DWELLING/BUILDING 1:1GARAGE/ACCESSORY STRUCTURE ❑ ADDITION O <br /> TYPE OF PERMIT(S): d D <br /> FILLING/GILDING ❑L _fCAMPING UNIT ❑.+'SUBDIVISION ❑ <br /> STRUCTURE/ADDITIONUSE: �!` <br /> o @/Cabi ; Commercial Business; Bedroom; Deck;etc.) J� <br /> BUILDING CONTRACTOR: e, d <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR m <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> z Cn <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O vl <br /> m <br /> T Z <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 m v <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. o <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),/j�Ob LLQ NCES TO <br /> BUILDINGS, ROADS, LAKE, LOT LINES. \�� �y ^� <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GR ED OR=,.I�l�// 0 v' <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER' ONTRACTOTC.,T►1 �tS <br /> MUST BE SIGNED AND DATED BY THE OWNER. �/.7,' 5 � <br /> � E 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFi�A/FON MAY�E D&WHE / �/ Op UJ " <br /> NEEDED. _"r(IVF 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 2 oN/N O n 7-Y U<, o <br /> � U <br /> CONDITIONS OF PERMIT: C l 5 <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. _1 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY 0�1 <br /> PERMITTED. I <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN <br /> ?THE <br /> ,,REEQUIRED WATER 1 l_ <br /> SETBACK AREA. cF' � C� <br /> 5. a, pC" /� I'/ l3yoa 8y J <br /> 6. / �// 1 O rl Yv �� C!` /� S� 0 3 n 00 v n F m <br /> m m �c — <br /> CD 0 <br /> 7. Z N N O <br /> o n <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my — O <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of d r`, . c <br /> a <br /> a : < : A <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize (D O : mm <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 County of Burnett relying on this information I am �� m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <br /> authorized person to have ac ss to the above described premises at any reasonable time for the purpose of inspection. rD CO <br /> CD ID <br /> SIGN HERE <br /> o : <br /> (signs ur If r or building contr t r) (date) <br /> ZONING ADMINISTRATOR C . <br /> -� <br /> r')0N <br /> Hi EH0 <br /> ���/� � O1 N N N OO <br /> Cn <br /> 1 O 1 O U O O <br /> TOW HIP PERMITS MAY BE REQUIRED ,VI <br /> (071e 3 /W <br />