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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -CD o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> y O <br /> y <br /> CD <br /> N <br /> OWNER ' /'�� l(„o TELEPHONE <br /> 6 T� / m_ C1 <br /> MAILING ADDRESS &KC '//t cr/i ADO 3 <br /> r � <br /> PROPERTYADDRESS <br /> LEGAL DESCRIPTIONreceipt <br /> see tax ' V" <br /> c )Se�fioh �3 �i•/� yo k'l6 Lr�-r3 csrt V-3 ��o� <br /> dDWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ -0-py 6�oVLdf c 0 <br /> TYPE OF PERMIT(S): ai <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: j <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) C <br /> r J <br /> BUILDING CONTRACTOR: /rru r- ✓ryr ,��eU <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> O JJ <br /> z <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. T Z� <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> m m <br /> NORTH(N). C O <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 Z <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 1 0 <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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS ° <br /> MUST BE SIGNED AND DATED BY THE OWNER. 0 1 1 <br /> O <br /> NOTE: <br /> BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. I „ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: n ' <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. <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 /> 6. CD C °O) °r 0 C a m <br /> CD <br /> p N C y y 0 3 <br /> 7. Z C N ry 0 0 0 <br /> O CD T`G R1 <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my G)w : O <br /> knowledge and belief it is true, correct and complete. 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 I recognize m ;0 <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- D to <br /> sue a permit. I further accept all liability which may be a result of the Count O o <br /> Zai <br /> �t_ring on this information I am m . o <br /> providing in this application. I agree to permit county officials chary et� QutlFy.o[dinances or other � i `D [ <br /> authorized r n to have access to the above described premises fit' fYll? t r' $e of inspection. D <br /> T O. <br /> CD D : <br /> SIGN HERE <br /> CD <br /> (signa of owner or building contractor) 24 (date) <br /> 3 <br /> ZONING ADMINISTRATOR11 4 ri, <br /> �n TOWNSHIP PERMITS MAY BE REQUIRED°ING N N N N <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE 6 / <br />