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Burnett County 7410 Co. Rd. K, No.102, Siren,WI 54872 Office of Zoning Administrator o G) Z <br /> APPLICATION FOR LAND USE PERMITS ` <br /> N <br /> � C <br /> d <br /> OWNER 1� ) �a TELEPHONE1�S <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS <br /> &9y7 A dile kNJ„V$ 9Q 6e,9AIkIr W sy(� � <br /> C4) <br /> LEGAL DESCRIPTION(see tax receipt) <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION (n <br /> TYPE OF PERMIT(S): v <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION a <br /> g <br /> STRUCTURE/ADDITIONOSE: ,y 0 <br /> nI <br /> (Home/Cabin; Commercial Business; Bedroom; D k; etc.) (n V <br /> ^ / d v <br /> BUILDING CONTRACTOR: 44J246ti 6 <br /> Z <br /> C <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81h X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. �J <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> T <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 _ y <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m qj <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m o4v <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. 9 <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. t 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 g <br /> NEEDED. a <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <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 /> mD m W 0 A <br /> 8. (D3amn � D � <br /> 7R m C <br /> 7. Z N COD O t0 <br /> P T� ' m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m —^� ' D <br /> PP (� 9 Y ) Y Y �� E <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of w in C <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- m ”1 G <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 a 1 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <br /> authorized person t have acceto the above described premises at any reasonable time for the purpose of inspection. m o <br /> SIGN HER (o Dy m <br /> 4lg8 re o ow erar building cont c or) (date) a <br /> ZONING ADMINISTRATOR (�, <br /> N fon O <br /> L� TOWNSHIP PERMITS MAY BE REQUIRED (A O (4 3 O <br /> Gck��3D HI PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE U) <br />