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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator ci Z <br /> APPLICATION FOR LAND USE PERMITS <br /> r <br /> y 2 J <br /> tlr� { C C <br /> OWNER �� ✓•�1`� � n <br /> l � J -�yy� c <br /> TELEPHONE <br /> O p <br /> w_ <br /> MAILING ADDRESS / O / J Ofbn:er WL <br /> PROPERTY ADDRESS <br /> 3 y /V / y 2a' <br /> LEGAL DESCRIPTION(see tax receipt) D (/ �� 2 Cn <br /> CD <br /> 2 <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE.ADDITION ❑ o <br /> TYPE OF PERMIT(S): rr""�� � � <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISIO;N ❑ S. <br /> a Q� <br /> X UD w f 8 k 4e,k �/rl r 11 0 / <br /> STRUCTURE/ADDITION USE: r o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) � <br /> BUILDING CONTRACTOR: <br /> >y <br /> m ^ , <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 W <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) 0 m <br /> m 0. <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). C O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m a <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 1 Z <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO 9 <br /> BUILDINGS,ROADS, LAKE, LOT LINES. O <br /> S. 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. F <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. N ° <br /> n <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: o C <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. 1✓ O <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY lI C <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. C91 -y�) <br /> 6. m y m n C D O m <br /> 7. m C <br /> Z fd O 0 : =(0 <br /> D <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my —w n <br /> all information contained in this application(including any accompanying schedule)and I further declare and that I recognize accuracy of m 0 o f�ri <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- I E E IM <br /> sue a permit. I further accept all liability which may be a result relying on this information I am w <br /> providing in this application. I agree to permit county official � ing county ordinances or other m <br /> authorized person to ave access to the above described premi a for the purpose of inspection. mCnE <br /> m o : <br /> 2 7 —C3 m i 'm i <br /> SIGN HERE 'n ? , <br /> (signature of owner or building contractor) (date) 1 0. <br /> ZONING ADMINISTRATOR <br /> —EURNE I 1 G (a 49 �r N <br /> N t n N N 0 0 <br /> TOWNSHIP PERMITS MAY BE I&4IRMERD Ln O <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> ga�� <br />