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Burnett County 7410 Co.Rd. K,No. 102,Siren,WI 54872 Office of Zoning Administrator _ o° o <br /> APPLICATION FOR LAND USE PERMITS . Q <br /> N O a'CS <br /> y <br /> C <br /> m <br /> OWNER TELEPHONE <br /> yl <br /> m O <br /> MAILING ADDRESSCD <br /> �S f <br /> uJ s ►� s �'i �, <br /> PROPERTY ADDRESS <br /> I <br /> LEGAL DESCRIPTION(see tax receipt) I l — 7 / <br /> m <br /> DWELLING/BUILDING ElGARAGE/ACCESSORY STRUCTURE ADDITION ElIn <br /> TYPE OFPERMIT(S): a <br /> FILLING/GRADING ❑ C MPING UNIT ❑ SUBDIVISION ❑ R, <br /> / <br /> T. <br /> STRUCTURE/ADDITION USE: S k rg 7 <br /> (Home/Cabin;Commercial Busines ; Bedroom; Deck; etc.) m <br /> BUILDING CONTRACTOR: .iY) o t/ (I +O N CL <br /> .i <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 71 SHEET OF PAPER. ANY INCOMPLETE OR m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> 31 N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T o <br /> '*t z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m o <br /> m jp . <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C <br /> NORTH(N). y <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 <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. P <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. ry <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 0 1 <br /> MUST BE SIGNED AND DATED BY THE OWNER. F <br /> 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 <br /> CONDITIONS OF PERMIT: C> <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. <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 /> S TBACK AREA. <br /> 5. I C :0O� D v D O V <br /> N N m n m M F m <br /> 6. m 3amxafD � <br /> N C y y 0 7 <br /> Z y W 0 .3 O <br /> 7. 0 T <br /> = cn : € ' m <br /> I declare that this application (including any accompanying schedule)has been examined by 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 m n E 60: <br /> OL <br /> vM <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o C <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- L7 , <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 m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <br /> authorized person to have access to the above descr'bed premises at any reasonable time for the purpose of inspection. o <br /> SIGN HERE A111Q <br /> signature of o K, building t etor (date) <br /> 1 <br /> ZONING ADMINISTRATOR ryaE <br /> \J "49M 64 <br /> 5& L)e. l/iJl (no cno0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> bU00 Q'e_ THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE -�' <br />