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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 3 <br /> N O» <br /> N <br /> c <br /> n <br /> OWNER ' i TELEPHONE <br /> V <br /> MAILING ADDRESS f-1 Z <br /> r <br /> 0 <br /> PROPERTY ADDRESS s �1 L (n v r Q S ; r`ti I <br /> LEGAL DESCRIPTION(see tax receipt) At <br /> C S ty� v I S I Gov 9 m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE E ADDITION ! <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> S. <br /> STRUCTURE/ADDITION USE: f4) .( t 4 I to-A a e- I L i <br /> (Home/Cabin;Commercial Business; edroom; eck; tc.) m <br /> BUILDING CONTRACTOR: <br /> v <br /> m <br /> Y % <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> .'0 m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 n ~,v/^�' <br /> T 1 Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m p <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). W �" `3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m o <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. lJ <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 1 N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS ?, o <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION"II�A�T QDO1pFr WENT ° UJ <br /> NEEDED. <br /> i <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: S Q <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PE K htllf ,-/,..�,_ 200 1 <br /> ISSUANCE. >` ` / r*,'^'` / <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE G 4 r/V <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY ?' <br /> PERMITTED. 6 ' <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. 1 <br /> 5. <br /> M m <br /> rrDi 0 > 0 <br /> m <br /> 6. 3 'a D XcL <br /> E m <br /> O (D C N y O J <br /> Z N O = O <br /> 7. O it Z1 <br /> M <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my G) C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m n v, <br /> n c � <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize : 'O0 mCDy <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 1I,,,, m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other 1Je <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. o <br /> CDM <br /> SIGN HERE ���5�U a^- a <br /> ( or build <br /> tura of o <br /> Ing contractor) (date) <br /> ZONING ADMINISTRATOR :r b <br /> N OI N N O O <br /> �(T OO�(T OO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />