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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 /> r {p <br /> �.rY <br /> OWNER !( (,� ��,Lf�•�_. TELEPHONE <br /> / CD v <br /> o <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS CA) ` (� Wl'� UJut�j 11�5 fir ~o <br /> `� `�OSO - <br /> LEGAL DESCRIPTION(see tax receipt) �Z r O 20� 0 <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ c <br /> TYPE OF PERMIT(S): r Cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDYISION ❑ <br /> STRUCTURE/ADDITION USE: <br /> (Hoe/(�(?ab_n; Comme cial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: ° <br /> 2_ <br /> v <br /> m ` <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR _n � W <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o. <br /> In <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m X <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS (EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> C O <br /> NORTH(N). to ° <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 I o <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 I <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 I <br /> MUST BE SIGNED AND DATED BY THE OWNER. ° <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN ° <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o (J <br /> CONDITIONS OF PERMIT: SSS Aj <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 /> c m 0 M6. q5 — <br /> ,7r <br /> ° > > ° o 161 <br /> 01 <br /> m � 3m X <br /> Z C y ° <br /> 7. ° to 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my �' c I � : 10 <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy ofall information contained in this application(including any accompanying schedule)and I further declare that 1 recognize ~: m ° mthat this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- � 0 <br /> sue a permit. I further accept all liability which may be a result of the County ofon this information I am "providing in this application. I agree to permit county officials charged with ther j <br /> authorized person to a access to the above described premises at any reas p I n• m n <br /> m n <br /> SIGN HERE <br /> (s nature of owner or building contractor) MlilE) j! ° <br /> ZONING ADMINISTRATOR URN <br /> CAUJ <br /> tTT COUNTY <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> ZONING <br /> THIS PERMIT SHALL EiPIR�Q��Y/EAR F_�OM.�AT �1$SU <br />