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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 \, <br /> C <br /> N <br /> , I i n <br /> OWNER ���� l <br /> � Y S D {� TELEPHONE 1 �� w 0 <br /> MAILINGADDRESS CD <br /> PROPERTY ADDRESS <br /> I <br /> a <br /> LEGAL DESCRIPTION(see tax receipt) Cl)CD <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ rp o <br /> TYPE OF PERMIT(S): Q <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION El �()�[�/_ a <br /> i o <br /> N <br /> `-f S1 �� L} 4 D l t'c IV, F e f.� �o r n h �a ° <br /> STRUCTURE/ADDITION USE: �0 <br /> (Home/Cabin;ComAiercial Busi ss; Bedroom; Deck; etc.) 2. <br /> rn <br /> BUILDING CONTRACTOR: C'-h Cva b ,1 y <br /> Z � <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> M N V_ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o C� <br /> m <br /> TI z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n w 70 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). N 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. 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. <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 OG <br /> MUST BE SIGNED AND DATED BY THE OWNER. o o ,\ <br /> F 1� <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 /> CONDITIONS OF PERMIT: o <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 �r <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA.5. ne n <br /> m wmo(Daf m <br /> 6. iD Sam Fnm <br /> a CD C: � <br /> 7. Z neo ? . <br /> ° -n'< : m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m <br /> PP C 9 Y ) Y Y E G) ? C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of d nv, <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m E o m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- D ' <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 m <br /> providing in thispIplication. I agree to permit county officials charged with administering county ordinances or other o E <br /> authorized p on to ave ess to the abAve described premises at any reasonable time for the purpose of inspection. m o <br /> SIGN HERE a <br /> (signal o uilding contractor (date) CL: <br /> ZONING ADMINISTRATOR <br /> fA fA fA fA69 N <br /> �L 0NN00 <br /> ro tO ro ro OO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />