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Burnett County 7410 Co. Rd. K,No. 102,Siren,WI 54872 Office of Zoning Administrator - o o <br /> APPLICATION FOR LAND USE PERMITS . <br /> o <br /> OWNER S -r# TELEPHONE - <br /> m <br /> MAILING ADDRESS 7ba >( <br /> PROPERTY ADD g �' �f'� ylf o <br /> Gx1 ��= / 9 I / JU <br /> LEGAL DESCRIPTION(see tax receipt) DQ - Q`/ L� WCL) m <br /> 9. <br /> DWELLING/BUILDING ❑ ARAG CCESSORY STRUCTURE ADDITION ❑ Cl) 0 <br /> TYPE OF PERMIT(S): v <br /> FILLING/GRADING ❑ CAMP UNIT ❑ SUBDIVISION El _a <br /> I � y 1 < <br /> STRUCTURE/ADDITION USE: d /t d`t� o <br /> (Home/Cabin;Commercial Business; Bedroom; Deck; etc.) <br /> kzzl <br /> .I <br /> BUILDING CONTRACTOR: <br /> C <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81h X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> 31 y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 o <br /> TZ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m `°. <br /> NORTH(N). C o <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 <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. pP <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO 0 <br /> BUILDINGS,ROADS, LAKE,LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N 0i <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. o o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERtP)? <br /> NHENNEEDED. hTHIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 1 // oCONDITIONS OF PERMIT: ((���� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF`1 ,^�y 1 J <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORE04Q/V//N"Co <br /> q <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY ( � <br /> PERMITTED. 1 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> 5.�SyETBACCK//ARr�E�A. This structure to be used as private residential <br /> garage/storage only. Not to be used for human 0 m = g � a � m <br /> 6. habitation. m 3 a m ,� _ m <br /> » ID Co m O 7 <br /> 7. Z N m O <br /> o =f0 <br /> T� m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m cn : D <br /> PP ( 9 Y ) Y Y Q2 iC <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of ma^n : , <br /> ; uM <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m o i C <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <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 m , <br /> providing in this application. agree to permit county officials charged with administering county ordinances or other ' o <br /> autho son to have c as to the abo a scribed premises at any reasonable time for the rpose f insp tion. -nm : c <br /> CD <br /> s'1 f m <br /> SIGN HE <br /> (signature ofow r or buildin contractor) (date) f CL <br /> c fWn [ t t <br /> ZONINGVNISTftTO a�((6 � <br /> TOWNSHIP PERMITS MAY BE REQUIRED / <br /> �2 THIS PER IT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE?� 8U'--a- <br /> /U <br />