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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 3 <br /> r <br /> N � <br /> N <br /> C <br /> f N / <br /> OWNER v TELEPHONE <br /> d <br /> O <br /> MAILING ADDRESS `-gj �/ G�'(pQ 1 <br /> r <br /> PROPERTYADDRESS <br /> tvL.4 <br /> (. OT (o � 1 <br /> LEGAL DESCRIPTION(see tax receipt) {( M �Z �3�� IZ 14b f 4 1 VM�N s lfl�p CD <br /> l f l �D <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ rn 0 Q1 <br /> TYPE OF PERMIT(S): n <br /> FILLING/GRADING ❑ CAM G UNIT F-1SUBDIVISION ❑ �. <br /> STRUCTURE/ADDITION USE: L n m <br /> ( ome/Cabin; Commercial siness; Bedroom; Deck; etc.) m <br /> BUILDING CONTRACTOR: <br /> v <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a V' <br /> �+ o Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> C o <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. ° <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO 9j C:5I , 1 <br /> BUILDINGS, ROADS, LAKE, LOT LINES. � W <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. IN <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS � <br /> MUST BE SIGNED AND DATED BY THE OWNER. n f <br /> D G <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. Z <br /> 0 <br /> CONDITIONS OF PERMIT: I t, , <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT �/ 1 <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. YV�� <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. ���� <br /> 5. �,e a)� REV 15f� � � C W 0 CD 0 <br /> g f _ F <br /> 6. '7- A- / Je bW Ej--W 110 m. x 3 n m 0, - `° 111 <br /> O N C y y O J <br /> Z c y � 0 O <br /> 7. O N T7G <br /> U) , ffl Q <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ; C <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of ap <br /> all information contained in this application (including any accompanying schedule)and i further declare that I recognize m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- d m rn : t7 <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 Q <br /> providing in this appli tion. I agree to permit county officials chargedwith dministering county ordinances or other �— G <br /> authorized person t ve a s o e abov describe mises at any reaso able time for the purpose of inspection. mCD . m a <br /> G a <br /> m <br /> SIGN HERE <br /> (si re of ne r buildi contractor) (dalo <br /> ZONING ADMINIST T R <br /> V/L/1.] �fA V2 di EAtc) <br /> 0 UtUt U• � <br /> TOWNSHIP PERMITS MAY BE REQUIRED (� <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE 9F ISSUANCE U <br />