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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> ^ r <br /> N <br /> ID <br /> C <br /> OWNER 011+n "an_ TELEPHONE <br /> �/1 "d �r <br /> DDRESS > Q �� � �-/�� O <br /> MAILING A <br /> f <br /> o <br /> PROPERTY ADDRESS <br /> ca ' r o Z-0 <br /> LEGAL DESCRIPTION(see tax receipt) rR-r- z 1 � `-( 0 At S W !^ I <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITIOIM (p <br /> TYPE OF PERMIT(S): Q <br /> FILLINGlGRADCAMPING UDIVISION ❑ ° <br /> STRUCTURE/ADDITION USE: o G <br /> (Home/Cabin, Commercial Business; Bedroom; Deck; etc.) rn <br /> m <br /> BUILDING CONTRACTOR: v <br /> m <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 /> CT] y <br /> Iv Ul <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 3 A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE 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 3 <br /> a <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. 9 <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. ry <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS I ° <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> o 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z !\7 t <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 /> NC Nmmn :0 m <br /> 6. m ,'c3 <br /> -o 0m7. C �"" o - 3 <br /> Z c: y o ' <br /> = rn : m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m O <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 v n � <br /> all information contained in this application (including any accompanying schedule)and I further declare that I recognize m my <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- J <br /> sue a permit. I further accept all liability which may be a result of the Coun on this information I am i o <br /> providing in this application. 1 agree to permit county officials charged s r VceA or other (D <br /> authorized person toAve access to bave described premises at any e p i pection. m ' <br /> n a : <br /> /�( e D <br /> cn a <br /> SIGN HERE _ <br /> ign ure of owne b 'Iding contractor) APR (date) o <br /> ZONING ADMINISTRATOR <br /> in e»4n <br /> oEA fN fA Hi- N <br /> N � wwNo <br /> TOWNSHIP PERMITS MAY BE REQUIREDZONING <br /> THIS PERMIT SHALL EXPIRE ONr YEAR FROM DATV OF IS UANgE <br />