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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator -0 o° o <br /> APPLICATION FOR LAND USE PERMITS . o <br /> y O _ <br /> N <br /> C <br /> CD <br /> OWNER DIM-7d TELEPHONE } <br /> CD 0 <br /> MAILINGADDRESS �� W j�,CQ/ l�f�/ /,S �, �'-iu� 4�- f <br /> _ 0 m <br /> 0 <br /> PROPERTYADDRESS� �) e � kd X M <br /> ,� i w �� <br /> LEGAL DESCRIPTION(see tax receipt) 13-39- !(o S <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ (n o <br /> TYPE OF PERMIT(S): r <br /> FILLING/GRADING 1:1 CAMPING UNIT ❑ SUBDIVISION El <` <br /> STRUCTURE/ADDITION USE: 0 1 c 0 <br /> �Lkme/Cabin;Commercial Business; Bedroom; Deck; etc.) m <br /> �-P <br /> BUILDING CONTRACTOR: 17E� � r <br /> v <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'h X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p y b r <br /> W W <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a <br /> ?I o ? <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m � � <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C <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 /> 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 0 O� <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN g <br /> NEEDED. <br /> ) <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT RJ <br /> ISSUANCE. q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. G <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. CrY - S 13 ,0 - /do <br /> s. j� ` S n( p T i a a �o <br /> Pn �J" z moy =tea <br /> 7. 9 T m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m � — D <br /> PP ( 9 Y ) Y y (( �� � M. , . C <br /> V <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of I C v, <br /> CL cn : <br /> all information contained in this application(including any accompanying schedule)and 1 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- <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 o E m i <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o '. <br /> authorize erson ave access to the above ribed premises at any reasonable time for the purpose of inspection. m m `: o <br /> �— m <br /> C mID <br /> m ' <br /> SIGN HER — <br /> (sign of owner or builds contractor) (date) CL <br /> ZONING ADMINISTRATOR <br /> Lo c r1300 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE �I <br />