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Burnett County 7410 Co.Rd. K,No.102,Siren,WI 54872 Office of Zoning Administrator m o1 a <br /> APPLICATION FOR LAND USE PERMITS • R, <br /> r <br /> N � <br /> N <br /> LeoC <br /> AOWNERTELEPHONE -C X138 ADDRESS Qu r/ l o �- <br /> a I n� y� o �m <br /> I � <br /> PROPERTY ADDRESS �� J j <br /> r, <br /> NE <br /> � I <br /> LEGAL DESCRIPTION(see tax receipt) L%V � + / —NE1 23 3 — o <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ 0 <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING CAMPING UNIT ❑ SUBDIVISION ❑ y. <br /> STRUCTURE/ADDITION USE: "v // a q/ ° <br /> ( e/Cabin;Commercial Business; Bedroom; Deck;etc.) U <br /> nn � <br /> BUILDING CONTRACTOR: ( } Z <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR n <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) c <br /> T o Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m :b <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE rn c <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)To m v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF c <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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. c <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS 2. <br /> MUST BE SIGNED AND DATED BY THE OWNER. O ° <br /> O � <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. c <br /> CONDITIONS OF PERMIT: 1 <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 /> s. mmcDiafm <br /> m <br /> 3 'a° ° % m <br /> m m _ <br /> 6. a m Cy w o <br /> ° T� M <br /> 7. m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> D <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of n y <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m <br /> that this information I am providing will be relied upon by the County of Burn"[ in in determining whether to is- , <br /> sue a permit. 1 further accept all liability which may be a result of the Cou �df n � nr glnrmation I am i w <br /> w <br /> providing in this application. I agree to permit county officials charged 1 n u o or other • <br /> authorized person to have access to the above ascribed premises at any sonab r e r i pection. -n : : o <br /> m m ; <br /> r <br /> ° <br /> SIGN HERE ✓ UL � (dat 11 . 1 CL <br /> (signature of ow r building contractor) !_f �_�, <br /> ZONING ADMINISTRATOR �3URNE i i <br /> ZONING N N O O <br /> ul O ro O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 1 <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />