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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - M o <br /> APPLICATION FOR LAND USE PERMITS <br /> 0 <br /> C <br /> l � <br /> OWNER /4,�/i ��L „AYl f}/`� TELEPHONE�' �9 S�,$''� p a <br /> uJ 553 <br /> MAILING ADDRESS ��9Z �y �d �lbs'T r O <br /> 0 m <br /> o <br /> PROPERTY ADDRESS <br /> i <br /> LEGAL DESCRIPTION(see tax receipt) CD <br /> 1r o_ <br /> Ll <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE RI ADDITION ❑ <br /> TYPE OF PERMIT(S): c <br /> FILLING/GRADING <br /> ��❑.l CAMPING UNIT ❑ SUBDIVISION ❑ <` <br /> STRUCTURE/ADDITION USE: Ui!/4�ti Of/ti�G r� � o <br /> �j (H /ee/CC bin;Commercial Business; Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: 4 <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> .t1 N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> Z v Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m a <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C W� o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF j Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 1 <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 IF I� N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONI *' E Q4- F,PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MANE DONE WItlSN ° <br /> NEEDED. v1 jI c� <br /> q <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. j���� s `W? o <br /> CONDITIONS OF PERMIT: Ior / coUA` (� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT I�/G ) 1, Iv <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 /> CD WSO0CDafm <br /> 6. m 3 C& M <br /> m C w o <br /> Z y 0 o O <br /> 7. 9T : 31 <br /> m E E O <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of 113 <br /> C : U': M <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize �J.1 m o mt7 <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- : 1 <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 : : w <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <br /> m : to <br /> authorized person to have access o the above described premises at any reasonable time for the purpose of inspection. o <br /> CD <br /> SIGN HERE C <br /> gn ure of own r or building contractor) (date) n <br /> ZONING ADMINISTRATO <br /> UA1 .,�r (('71 EA f9 fA 6S N <br /> D N N N N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED �,I V1 - <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUA( INCE, a <br /> �M <br />