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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 /> C // y <br /> OWNER 21 C ll f ( - A ` TELEPHONE wCD <br /> e <br /> ��a U ,fid l�U, rer ��3 <br /> MAILING ADDRESS � <br /> 4 <br /> PROPERTY ADDRESS S I <br /> LEGAL DESCRIPTION(see tax receipt) <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION O (n <br /> TYPE OF PERMIT(S): Cn <br /> FILLING/GRADING ❑ CAMPING UNIT SU DIVISION ❑, n <br /> STRUCTURE/ADDITION USE: t <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) m <br /> BUILDING CONTRACTOR: <br /> 4 <br /> CDv <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR (� <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m �J <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) OIn <br /> a <br /> M Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 m j0 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)A14D INDICATE m <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO INrt a <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OH M)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. 0 <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 C <br /> MUST BE SIGNED AND DATED BY THE OWNER. o0 I <br /> o � (\ <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DNE WHEN �» <br /> NEEDED. 0 <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 �. <br /> ISSUANCE. t <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. C <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> CN <br /> 5. _ Crcu <br /> 6. m 3CL COD xaDM <br /> N C y n O <br /> 7. Z w a O <br /> o 21 E J` m <br /> declare that this application (including an accompanyingschedule has been examined b me and to t e best of m — ^� ui O <br /> PP ( 9 Y ) Y Y G)c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail an accuracy of m n <br /> all information contained in this application(including any accompanying schedule)and I further declare th It I recognize m 5 S m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining hether to is- m <br /> sue a permit. 1 further accept all liability which may be a result of the County of Burnett relying on this inf Imation 1 am m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <br /> rn: <br /> authorized person)to have access to a <br /> the above de ed premises at any reasonable time for the purpose df inspection. o <br /> CD <br /> SIGN HERE 5 y <br /> (signatu of owner or building o (date). o. <br /> ZONING AD ISTRATOR / �'• <br /> O fA 6A E� N <br /> TOWNSHIP PERMITS MAY BE REQUIRED a <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE ]h <br />