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Burnett County 7410 Co.Rd.K,No.102,Siren,WI 54872 Office of Zoning Administrator -D c) Z <br /> APPLICATION FOR LAND USE PERMITS 3. < <br /> 9yo <br /> C <br /> OWNER XA F/( N ( -A TELEPHONE L/ <br /> MAILING ADDRESS 412 0 e/ l�(ff l e A R (2 L, /\ �( �J D' ' - C l <br /> PROPERTYADDRESS UU 1: 5 % fL /v z/ `I l7 w 0a l6 / wv� <br /> �S)01 <br /> LEGAL DESCRIPTION(see tax receipt) <br /> 131j . <br /> r �tUis 3 d C <br /> DWELLING/BUILDING 3— CESSORY STRUCTURE <br /> ® ADDITION ❑ cn 0 <br /> TYPE OF PERMIT(S): Q <br /> FILLING/GRADING / CAMPING UNITI El SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: 1 <br /> 0 <br /> ( me/Cabin; Commercial Business; Bedroom; Deck; etc.) U) (a <br /> BUILDING CONTRACTOR: m <br /> CD <br /> 3 <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O " O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). N _ o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO m V <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. 9 <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. 1 O <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 i <br /> MUST BE SIGNED AND DATED BY THE OWNER. 0 <br /> O 0 <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN 0 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 0 <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY QJ <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER Q <br /> SETBACK AREA. <br /> 5. <br /> m md� � oa0 'o <br /> 0 F m <br /> 6. m x 3 a m M a x <br /> o IDc y " o 3 <br /> 7. Z y m CD ° `° <br /> 0 -n� . m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m — O <br /> PP (� 9 Y ) Y Y <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of C <br /> o �_ <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m (n <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 d o <br /> providing in this application. I gree to permit county officials charged with administering county ordinances or other <br /> authorized person to hav c s to the above described premises at any reasopa n. fD <br /> -n <br /> CD D : <br /> SIGN HERE D a i <br /> (signature of owner or building contractor) (date) 3 o <br /> ZONING ADMINISTRATOR J OCT <br /> Li U <br /> TOWNSHIP PERMITS MAY BE REQUIREDBURNETT COUNTY (0`� N N <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSG <br />