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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> ` o _ <br /> OWNER � F' Y^�'�7'C-2C TELEPHONE I�^ . 3 2 7_ g 9 g? a <br /> o a <br /> /( m <br /> MAILING ADDRESSO <br /> 71 tc- PF06kzc �7 �-Lf�3 '7 <br /> r <br /> PROPERTY ADDRESS I 1 <br /> I <br /> LEGAL DESCRIPTION(see tax receipt) m <br /> m <br /> CO <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ Ul <br /> TYPE OF PERMIT(S): v <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: by C- o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) � <br /> L� m <br /> BUILDING CONTRACTOR: <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T = <br /> 0 w <br /> DIRECTIONS FOR PLOT PLAN DRAWING- (AERIAL OR TOP VIEW) p , <br /> -n n <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n 0 A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE Im <br /> NORTH(N). <br /> O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO m a <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. 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. I I <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N W <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR,ETC.,THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. -- <br /> o U1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a Q 'J <br /> NEEDED. n t <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. a ) <br /> CONDITIONS OF PERMIT: I `1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> Vv <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 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> , a * m <br /> C <br /> 6 .n ,'c3 nm 0C A <br /> Cr p 3 <br /> 7. Z C fG ry 0 : 7 rp <br /> O A T'C m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m cj �' A <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 lJ : m n : N : C <br /> all information contained in this application (including any accompanying schedule)and I further declare that I recognize J' M Ci I m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Is- p , . <br /> sue a permit. I further accept all liability which may be a result of the Coun is O` 0 <br /> P P Y Y ty Infor tion I am 1" ? m : o <br /> providing in this application. I agree to permit county officials charged wi I erm t 1 � 4 r other <br /> authorized person to have access to the above described premises at any r __ Ip s Cof i ction. ` m <br /> T C : <br /> m ' ' D E <br /> SIGN HERE <br /> (signature of owner or building contractor) "` W <br /> ale) I ((���� I o <br /> „ L/�/ <br /> ZONING ADMINISTRATORI ` , i(- <br /> OO N( W W NOT O <br /> ZONING <br /> TOWNSHIP PERMITS MAY BE REQUIRED o o o <br /> T PERMIT SHALL EXPIRE ONE YEAR FROM DAT SU N <br /> (jYli Ie "tea 4o 7ev�nl� — -06 <br />