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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS . <br /> ���,,.r��s�,�/ CD <br /> OWNER �A'?�/ UY/^'(�LSf.✓ TELEPHONE <br /> /� O <br /> MAILINGADDRESS t`/Ibi/-tr Z�� Z �e- A, �'/°�p0.✓t`K !. O <br /> PPI ped {� <br /> PROPERTY ADDRESS e'','a <br /> / A �/ /W <br /> LEGAL <br /> Q IN u <br /> LEGAL DESCRIPTION(see tax receipt) /� ^T CS1�j�( Y, 17 /2�, <br /> o_ <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ C o <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> w �) <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) U) <br /> BUILDING CONTRACTOR: <br /> �� . <br /> C <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n 9 !� <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O - <br /> �1 m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> In <br /> T � Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 m � <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). CCn 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO m 3 <br /> a <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. ° <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 a <br /> MUST BE SIGNED AND DATED BY THE OWNER. / ,"t <br /> p V <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN ° - — <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o C> <br /> CONDITIONS OF PERMIT: 0 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. W <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 /> M mW iu 0 0n * m <br /> 6. m. x3 'am O a <br /> o Cy o3 <br /> OZ 5 7 � <br /> 7. m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my � �j A <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 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- 0, m ' Cn 17 <br /> 0 1iA G) <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information 1 am m o <br /> providing In this application. I gree to permit count officials charged with ad nances or other d ° m <br /> P g PP 9 P Y g fly dLr 9 m <br /> authorized person to have ac9g, <br /> to th above described premises any rea tl a Eqe bfiLM pe tion. T Q <br /> ^' I a <br /> SIGN HERE <br /> (signature of owner or building ontractor) SEP .1 (date) I� I <br /> L 20 U <br /> ZONING ADMINIS ATOR <br /> BURNETT COUNTY ' <br /> O VI O Ul N <br /> TOWNSHIP PERMITS MAY BE REQUIRED ZONIN <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />