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c <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator T D Z <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> / <br /> fa)(- &35- 4'( 00 <br /> OWNER TELEPHONE �— <br /> m <br /> a�3�/ _ o <br /> MAILING ADDRESS F <br /> cul <br /> PROPERTYADDRESS <br /> 3�s <br /> LEGAL DESCRIPTION(see tax receipt) . (G <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION <br /> TYPE OF PERMIT(S): K KnYiIC c IVB <br /> FILLING/G A INCL <br /> CAMPING UNIT ❑ SUBDIVISION ❑ r C <br /> STRUCTURE/ADDITION US <br /> (Home/Cabin; CommBusiness; droom; Dea; etc.) C <br /> BUILDING CONTRACTOR: (� <br /> m 'S <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/,X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 (d <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n - <br /> O <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p <br /> n a <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n �j <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 Z <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 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. C> <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N pVV <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. <br /> o � � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. 7J <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Zj 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. C7 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 6. Wmm 0n : m <br /> m x3 am m A <br /> a 0(D 0' � 3 <br /> 7. Z c m m o 1 <br /> P m -nom " i T <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m A <br /> PP (� 9 Y ) Y Y <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application (including any accompanying schedule)and I further declare that I recognize �n ' C c - m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- r : cn <br /> a, 0 <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 : o <br /> providing in this application. I agree to permit county officials charged with adm' n er n CD <br /> authorized perso have a s to the above described premises at any reaso f h o <br /> m D <br /> SIGN HER a <br /> t» i ? i n : <br /> (sig re owner ding contractor) •�� 8(d to)` <br /> ZONING ADMINISTRATOR 7 A <br /> BURNETT COUNTY <br /> O N CT W W N O <br /> T WNSHIP PE ITS MAY BE REQUIREDt�o u o n n n o <br /> ZONING <br /> THIS PERMIT SHALL EXPIRE ONE YEAR F OM DATE OF ISSUANC <br />