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Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator -U � Z <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> - r <br /> y O <br /> y . _ ' M <br /> �c <br /> 1 <br /> aowNER 0- TELEPHONE 5 - yl 38 <br /> - <br /> o <br /> d <br /> �-�^ m <br /> MAILINGADDRESS .Sp" /2 / Yet S C-;." R A O <br /> F <br /> 0 <br /> PROPERTY ADDRESS S o o tYr / s Sy O / I 1 . <br /> LEGAL DESCRIPTION(see tax receipt) S - si�)_ sCl_ 14 YI/ / S l <br /> 1 CD <br /> rn <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE It11 ADDITION ❑ y 0 rh <br /> " <br /> TYPE OF PERMIT(S): c <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ �- <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial usiness;Bedroom; Deck;etc.) Cn <br /> 9 m <br /> BUILDING CONTRACTOR: ! •ztzs C).A r Q ��r <br /> Z � <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 /> O � W <br /> tI N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) C <br /> O a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 0 <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. Z <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO d(� <br /> BUILDINGS, ROADS, LAKE, LOT LINES. c \ <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 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> 4 SChoW <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE *ky, INo <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. J f� j o <br /> CONDITIONS OF PERMIT: C ` <br /> �i�7TT <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS O 1 <br /> ISSUANCE. �Qf� COUN` T <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORKINE'NG <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY r <br /> PERMITTED. V 1 <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. // / // / ^ �/y,,, n <br /> 6� i1 �1� �J//'� / l U G ) v �X w!X QY� "lW p n v <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of d n vi C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m C <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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m p <br /> G� -n o <br /> SIGN HERE .c��i��!//� 3�- e M <br /> �O- 6 Fn d <br /> C : <br /> (signature of o er or building tractor) n <br /> /p (date) (Ql <br /> ZONING ADMINISTRATOR Vl /�I <br /> fA fA f4 fA N <br /> `�-/1 NNNNOO <br /> N O(T (P O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />