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Burnett County 7410 Co.Rd. K,No.102,Siren,WI 54872 Office of Zoning Administrator - o Z o <br /> APPLICATION FOR LAND USE PERMITS . <br /> ^' r <br /> N O <br /> N <br /> C <br /> W <br /> OWNER /✓O TELEPHONE <br /> O <br /> MAILING ADDRESS � <br /> V _ 7 <br /> PROPERTY ADDRESS C�"( D �( � I 0A 6 1, <br /> o <br /> LEGAL DESCRIPTION(see tax receipt) <br /> (Di <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION JLY Cf) 0 <br /> TYPE OFPERMIT(S): C7 f - <br /> FILLING/GRADING ❑ CAMPIN�IT ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITION USE: / Q 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) w <br /> BUILDING CONTRACTOR: D / n <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR r 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> c C- 4, <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o31 Z <br /> - <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m w jo <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB) NO INDICATE <br /> C a <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDIN (S)TO m o 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(O WM)OF z <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 DISTA 4CES TO C-I+ <br /> BUILDINGS,ROADS, LAKE, LOT LINES. t <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,. ONTRACTOR, 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 IF HEN q <br /> NEEDED. If <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. #4 o <br /> CONDITIONS OF PERMIT: g�J �} — <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF% <br /> ISSUANCE. ZQ/u/.C�U� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORE (' <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 /> m ymr0IDa0 C, � T <br /> a m CN <br /> Z y 0 o ; ' <br /> 7. o <br /> o T. >7 <br /> � <br /> =cn : D <br /> 1 declare that this application (including any accompanying schedule)has been examined by me and to the best of my <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of w o E n <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m C 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. 1 further accept all liability which may be a result of the County of Burnett relying on this information I am m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <br /> m Cn E <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. CD o <br /> (D W <br /> SIGN HERE kJc�t� -5 - r Q d' <br /> s g tura of or building contractor) (date) ° ` a <br /> ZONING ADMINISTRATOR rr�1 I E <br /> " fA fA fA ro N <br /> NO <br /> TOWNSHIP PERMITS MAY BE REQUIRED 3 u, o cn cn o <br /> f4i t� THIS PER SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE `$()p� <br /> S,1�5`�� f 1���� <br />