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Burnett County 7410 Co. Rd. K, No.102,Siren,WI 54872 Office of Zoning Administrator v G) Z <br /> APPLICATION FOR LAND USE PERMITS 3° ° <br /> r <br /> N O <br /> y <br /> C <br /> OWNER C.�. TELEPHONE <br /> MAILING ADDRESS <br /> PROPERTYADDRESS L %f / /jl�✓'��✓S �1 t re0� ?ke-3 4/t, all <br /> /i<i"►' s.f CkZI/,�r�-�.� /VE � � �`-�c�/ ��- vT �7 � � o <br /> LEGAL DESCRIPTION(see tax receipt) ��,L' rJ) ,t/ y��s, �6T ` �3K�Nr ���/✓ t� j C <br /> DWELLING/BUILDING // GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ rn o <br /> TYPE OF PERMIT(S): c <br /> Q <br /> FILLING/GR DING CAMPING UNIT [I SUBDIVISION ❑ a T- <br /> 5. <br /> STRUCTURE/ADDITION USE: c ? <br /> (Home/Cabi ommercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/�X 11 SHEET OF PAPER. ANY INCOMPLETE OR O � <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O (� <br /> n n <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <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 <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. O 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. Q <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS O l <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> o <br /> O :3 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. <br /> 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS Oo <br /> F PERMIT: (� (n <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. "" Q <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. <br /> 5. c' si�e, a, kic Ce-- <br /> X co Or DODOy <br /> m cmd0CDaf m <br /> 6. m � 3 'o Ox;o <br /> O N C y N 0 3 <br /> 7. Z C n O 4 <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G) q 10 <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of M U C c C <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize m c m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- in <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett rel <br /> ing on this informal' I am m o <br /> providing in this applicatio a to permit county offici s charged with ad i 'i gLrSlor o her p E m i <br /> authorized person It to tre a escribed ises at any reaso I f p o cji n. m <br /> -n : d <br /> D <br /> SIGN HERE w a ; <br /> (signatur of owner or bu' ing contractor) OCT 2 /�9 t <br /> ZONING ADMINISTRATOR (� <br /> 141- 9S V/Sf)33 p�;,� BURNETT COUNTYc� �N <br /> TOWNSHIP PERMITS MAY BE REQUIRED ZONING 0N W W N O <br /> �ocn0 cncncno <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE C <br /> ma h Tf G�LLQf She //-/s"&I <br />