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Burnett County 7410 Co.Rd. K, No.102,Siren,WI 54872 Office of Zoning Administrator _0 o° o <br /> APPLICATION FOR LAND USE PERMITS �. <br /> r <br /> CD <br /> rCs-� 2 <br /> OR '♦Tl / TELEPHONE—JV3—� (— ( J a <br /> OWNER 011/1 lJ^tl ✓�7 p (Z— o <br /> ' ` II O <br /> MAILING ADDRESS <br /> CD <br /> r CD <br /> PROPERTY ADDRESS 4PPLW <br /> LEGAL DESCRIPTION(see tax receipt) — � 1—I m <br /> Cj <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ 0 <br /> TYPE OF PERMIT(S): oP <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ S. <br /> N <br /> STRUCTURE/ADDITIONUSE: (7Y1(� D <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) in <br /> I44rL To; q <br /> BUILDING CONTRACTOR: CH CLIA 012—G CQ?45TkUCT L OV4 <br /> Af-2 I4o(LT9 512cF{ 04m6t'06,6, A) S5(4 <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE ORIn3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> � N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> T <br /> ?1 O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m �o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> C o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <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. <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 /> 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 In 0 I <br /> MUST BE SIGNED AND DATED BY THE OWNER. (1 O <br /> WW o <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. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT �J Y <br /> ISSUANCE. I U <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 /> CD m d 0 a f m <br /> 6. m. 3 am <br /> a >7 <br /> 'O N y N <br /> O ; <br /> 7. P y "` ' i m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m — 0 <br /> PP ( 9 Y ) Y Y Oc C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of a <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize mImCD <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- J <br /> sue a permit. 1 further accept all liability which may be a result of the County of Burn I ' �nformatlon,Iam nproviding in this application. I agree to permit county officials charged with adm' I c rij�ther <br /> authorized person to have access to the above described premises at any reason I i c O* m m o <br /> CD mi <br /> (D <br /> SIGN HERE <br /> (Signature of owner <br /> or building contractor) I + jUL — jdaw <br /> ZONING ADMINISTRATOR COUNTY <br /> cNi� ocicio <br /> Ln <br /> TOWNSHIP PERMITS MAY BE REQUIRED ZONING <br /> W U1 A; <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE v)�'1U} <br />