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Burnett County 7410 Co.Rd. K,No.102,Siren,WI 54872 Office of Zoning Administrator - 0 0 <br /> APPLICATION FOR LAND USE PERMITS <br /> y O <br /> m <br /> c <br /> OWNERe/ TELEPHONE <br /> CD <br /> MAILING ADDRESS + O J 4plot IVS <br /> PROPERTY ADDRESS <br /> I _e_ <br /> LEGAL DESCRIPTION(see tax receipt) m <br /> DWELLING/BUILDING 0 GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ <br /> TYPE OF PERMIT(S): W c <br /> c <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> �( N <br /> STRUCTURE/ADDITIONOSE: G��„ ft 0(0 3b ° <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) ' <br /> h <br /> BUILDING CONTRACTOR: C C.�T <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR � <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> O <br /> M W <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 o. ZN <br /> ?t o z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). y 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 pp� <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. "J o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO t <br /> BUILDINGS,ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANSIp 0. <br /> MUST BE SIGNED AND DATED BY THE OWNER. kji to <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY REpONE WHEN y` <br /> NEEDED. 4C <br /> r <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> J I <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT { q <br /> ISSUANCE. .1 `V't7 00 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELIISE'. NET "q ' a <br /> 3. NO NO GR TEDG OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY t7ON'A� V <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> iC ym sn 0 (D CL- F m <br /> 6. 03nmX TM <br /> m <br /> 9 N C y y 0 C <br /> 7. Z y '(OD 0 : a <br /> O T`G M <br /> I declare that this application (including any accompanying schedule)has been examined by me and to the best of my G)c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m ° ; v, <br /> ^ 01 '• M <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize C O O me <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 o <br /> authorized person have cces the bove de ribed premises at any reasonable time for the purpose of Inspection. m o <br /> SIGN HERE _. 51 <br /> V <br /> (D ; <br /> E <br /> (signs ure of owns building contract / /� �, (date) i ° <br /> ZONING ADM ISTRATOR L a �l <br /> `�- Q3 � O fA FA FA 0 N <br /> N o N N N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED �Cn O M L" O O <br /> ,+td(_ed c2tif af' THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE &f lS4 PJ <br /> yigm"" is 4-4, <br />