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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator CD <br /> - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> OWNER TELEPHONE <br /> m , <br /> N O <br /> MAILINGADDRESSI,7 <br /> PROPERTYADDRESS <br /> 1 <br /> l — ' <br /> LEGAL DESCRIPTION(see tax receipt) `G/ y U) 3o <br /> DWELLING/BUILDING ❑ GARAGEIACCESSORY STRUCTURE ❑ ADDITION (n 0 �- <br /> TYPE OF PERMIT(S): Cjq1D1 n <br /> FILLING/ ADINGJ❑ CAMPING UNIT ElSUBDIVISION El <br /> STRUCTURE/ADDITION USE: / / � ®�� /`�1 ' • �l V o <br /> ( ( o /Cabin; Commerci Usiness; Bedroom; Deck; etc.) ( d <br /> BUILDING CONTRACTOR: Q1 l(�/G � F✓� /( W <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN SY:X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 ( r_ <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p EF <br /> C r� <br /> DIRECTIONS FOR PLOT PLAN DRAWING_ (AERIAL OR TOP VIEW) 0 a 1 ` <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 � � <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS (EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> CNORTH o <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. ° <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. :E <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. ry <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 0 <br /> p � 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN in ° <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: (� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT T ' <br /> ISSUANCE. r , <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. w <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY d <br /> PERMITTED. I <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> S TBACK AREA. <br /> aj 5. P2n S�ree� fin(� oti c✓ _S <br /> u m C 0 0 O a f m <br /> 6. m F 3 n m x a' 'D <br /> 0 <br /> 7. 0 N (n T G <br /> _ U) m <br /> PP (including Yaccompanying ) Y D <br /> I declare that this application mcludin an schedule has been examined b me and to the best of my � c <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> V 1 <br /> all information contained in this application (including any accompanying schedule)and 1 further declare that I recognize m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- C <br /> sue a permit. I further accept all liability which rpay bie;d:result of the County of Burnett relying on this information I am0providing i hr applicatiorr. a to permit co i ials charged with administering county ordinances or other CDETauthorize pers o h e ac the above de c emises at any rea a tion. m a <br /> n E <br /> SIGN HE E <br /> gn of owner g co tractor) f,� (date) o <br /> ZONING A INISTRATOR N 2 2 2M5 ` <br /> to <n En <br /> �Vi 69 EA EA� N <br /> O N CM1 W W N O <br /> TOWNSHIP MITS MAY BE REQUIREBURNETT COUNTY <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF IS$ <br />