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Burnett County 7410 Co. Rd. K,No. 102,Siren,WI 54872 Office of Zoning Administrator m o 0 <br /> APPLICATION FOR LAND USE PERMITS . <br /> N O <br /> OWNER k�� P� � TELEPHONE LET) <br /> p <br /> /� Y r 1 /(�� ^ <br /> MAILING ADDRESS 71go V�() �2'1 v� F�7N*�( f ) �►�j'�' J m O <br /> LLL r <br /> 0 <br /> PROPERTY ADDRESS SPff I \ <br /> O/ v <br /> LEGAL DESCRIPTION(see tax receipt) S6L .. sw—IVE- 7R'v M 6 )', rn <br /> a <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE K ADDITION ❑ o` <br /> TYPE OFPERMIT(S): o <br /> FILLING/GRADING ❑ CAMPING UNIT ❑Y SUBDIVISION ❑ �' a <br /> STRUCTUREJADDITION USE: Nei la S IAC P> 3 /460 X(a S. <br /> —(Home/Cabin;Commercial Business; Bedroom; Deck;etc.) <br /> m <br /> BUILDING CONTRACTOR: V y <br /> Z � <br /> D <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LE T AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> 0 y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) a O <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n W <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE ^t l� <br /> NORTH(N). � o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDIN6(S)TO m 3 <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. 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. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. 01 <br /> v � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN l AJ <br /> NEEDED. n (TN; <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <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 /> SETBACK AREA. <br /> 5. <br /> 6. ISI m 3 CIO FaT m <br /> 'O <br /> CD <br /> 7. ZN CD <br /> N O J Ip <br /> P T'< i : M <br /> - i-jm <br /> I declare that this application (including any accompanying schedule) has been examined by me and to Ilhe best of my (� <br /> { c ? C <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of VC <br /> all information contained in this application(including any accompanying schedule)and I 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- <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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m o <br /> CD <br /> i m i <br /> SIGN HERE <br /> (signature of owner or building contractor) t ( te) . CL <br /> UJI: <br /> ZONING ADMINISTRATOR 1 JICA fA <br /> yC3f� pprAHy <br /> TOWNSHIP PERMITS MAY BE REQUIRED vi <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE °{ <br />