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Burnett County 7410 Co.Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator -0 o 0 <br /> APPLICATION FOR LAND USE PERMITS . <br /> o � <br /> 41 <br /> y <br /> OWNER (Z -/t/ C, �, /3EL L p TELEPHONE 6& G <br /> m OI„ <br /> MAILING ADDRESS '„Z? 3 C'f cf S720AI6 q^7z-- Rot W <br /> , ,/> � fs`f3 R;;4 <br /> mPROPERTY ADDRESS vV C 1�STri/� f��LEGAL DESCRIPTION(see tax receipt) , l ofDWELLING/BUILDING 9. GARAGE/ACCESSORY STRUCTURE ❑ ADDITI ° <br /> TYPE OF PERMIT(S): <br /> FILLING/GRA G ❑ CAMPING UNITSUBDIVISION ❑ !-fit" `r - � " -- <br /> STRUCTURE/ADDITIONUSE: 3�J Q (� <br /> Home Cabin;Commercial Business; Bedroom; Deck; etc.) (1 rtr <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR m <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> fA <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) OQ O <br /> o z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m :b2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> C o <br /> 3. SHOW DIMNORTH ENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO <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 :E <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. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERq()N <br /> NEEDED. <br /> c Q� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Ocr 2 '13 0 <br /> «l z <br /> CONDITIONS OF PERMIT: ft <br /> 3 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PEITMI VETTn(�' p C <br /> ISSUANCE. CvvN <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE?O10N6T `-' <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 d m o m a i 10 <br /> M <br /> 6. CD v C <br /> CD <br /> m C y <br /> Z N O E �� <br /> 7. o -n 77 <br /> D <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my O 'c C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of d O v, <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize IDm o m <br /> that this information I 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 ro <br /> providing in this application. I agree to permit count officials charged with administering count ordinances or other <br /> p 9 PP 9 P Y 9 9 Y `• <br /> CD <br /> : m f <br /> authorized person to h access to the above describe mises at any reasonable time for the purpose of inspection. - o <br /> CDm <br /> SIGN HERE <br /> o�'D <br /> ignature of owner building c ctor) (date) n� a <br /> ZONING ADMINISTRATO m ` <br /> TOWNSHIP PERMITS MAY BE REQUIRED Y 6!?�Q0�!h l N <br /> to" THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE GUS�j� <br />