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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator -0 OZ <br /> APPLICATION FOR LAND USE PERMITS . <br /> • r <br /> N 0 <br /> N <br /> OWNER rO Hk56� TELEPHONECD <br /> L/ �/ q CD = l n <br /> MAILINGADDRESS 7/ �� �6 A/r �� }�� �L��� U .�7' 1M <br /> —�! <br /> 0 <br /> PROPERTYADDRESS S14-1//f� <br /> LEGAL DESCRIPTION(see tax receipt) es} 1� ti <br /> P o l�S Ca L� 1 9�- yU-1:7 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ (�, o <br /> TYPE OF PERMIT(S): ' <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> a <br /> <_ I <br /> STRUCTURE/ADDITIONOSE: u 712'L I EZ _SAct d 11 1[>>(10-161 0 <br /> (Home/Cabin; Commercial Business;Bedroom; Deck;etc.) m <br /> m <br /> BUILDING CONTRACTOR: <br /> M <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN BY:X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n _ <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> n a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m T <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <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. o <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 /> S. 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 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN ao <br /> NEEDED. M. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. � / o <br /> CONDITIONS OF PERMIT: C <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PER �f ( <br /> ISSUANCE. <br /> ty;� COO? Q 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. �-Tl <br /> 3 PNO ERMITTED. <br /> OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY s?ON/ti/O(/N� <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> ;a nrDODO -V <br /> 6. N 3 nm Oam A <br /> C N N O 3 <br /> 7. Z N CD O <br /> P : "! 2 : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my �j c A <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that 1 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 recognize m o v <br /> that this information 1 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 permit county officials charged with administering county ordinances or other fv,�' o <br /> authorized person a access o e ove de ribed premises at any reasonable time for the purpose of inspection. T' . D o <br /> CD m <br /> CD <br /> SIGN HERE <br /> n ` a <br /> (sig`ns / f owner uilding contractor) (date) '/Y.J <br /> ZONING ADMINISTRATOR �/� /// ) <br /> " 69 N)0 N <br /> N "IN) O O <br /> 07(T O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />