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Burnett County 7410 Co.Rd. K,No. 102,Siren,WI 54872 Office of Zoning Administrator "oO Z <br /> APPLICATION FOR LAND USE PERMITS . o of <br /> N <br /> N <br /> T ) C <br /> OWNER // � U JC KS Q T� TELEPHONE .t 3�-� —3195' <br /> CL <br /> 'a <br /> w <br /> m <br /> MAILINGADDRESS <br /> PROPERTYADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) 77/1 GWED pfd o <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ® ADDITION ❑ rq o <br /> TYPE OFPERMIT(S): r 11/ <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ CS. _ I`,•' <br /> C,-A K A6- 76 <br /> STRUCTURE/ADDITIONOSE: 0 <br /> (Home/Cabin;Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81h X 11 SHEET OF PAPER. ANY INCOMPLETE OR my <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m0 W <br /> c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p <br /> m o. <br /> T v <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. Z <br /> m � 70 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). <br /> n <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 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 d <br /> BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <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. o <br /> o � � <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. 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. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. yy <br /> D mmDiAa * m <br /> 6. m S arm x 71 <br /> W C 1a' <br /> 7. Z y m „o p a a <br /> O it< 3I <br /> =Cn: € m <br /> I declare that this application (including any accompanying schedule)has been examined by me and to the best of my 25 2 : O <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of E d 0 '• to E C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I CL o, : <br /> recognize m o ; my <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. 1 further accept all liability which may be a result of the Coun of B rnett remotion I am ? w <br /> providing in this application. I agree to permit county officials charged I c y es or other o <br /> authorized person to have access to the above described premises ata f o nspection. m <br /> I <br /> m o : <br /> SIGN HERE (t � <br /> sign we of w or building contractor) I AU6 2 6 (da )% a <br /> ZONING ADMINISTRATOR >ti� r�1 ' <br /> KILL fA fA fA fA N <br /> TOWNSHIP PERMITS MAYBE REQUIRED' <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />