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Burnett County 7410 Co.Rd. K,No.102,Siren,WI 54872 Office of Zoning Administrator 0 0 <br /> APPLICATION FOR LAND USE PERMITS <br /> r <br /> N 2 <br /> w <br /> CL <br /> c <br /> _ Q m <br /> OWNER K �'�' TELEPHONE <br /> m O <br /> MAILING ADDRESS <br /> f � � <br /> PROPERTY ADDRESSe- <br /> l <br /> LEGAL DESCRIPTION(see tax receipt) P`L J Lb T L C <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION El (n O <br /> TYPE OFPERMIT(S): a <br /> FILLING/GRADING El CAMPING UNIT ❑ SUBDIVISION ❑ La - <br /> STRUCTURE/ADDITIONUSE: a `�x ` iOf�M� ��QAt/ 1�r 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: 04t �&) 7 <br /> Z <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> W a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T c <br /> ?t O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m i3 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). W 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. P <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 \j <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. Iv W <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 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. y� <br /> C <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o t <br /> CONDITIONS OF PERMIT: Q <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. C <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY C <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> mm>0aFm <br /> n _.m <br /> 6. m 3 a w ,c w <br /> a wmorn > > <br /> 7. <br /> m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m 6 1 ' O <br /> PP (� 9 Y ) Y Y �� C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m o : en <br /> CL c" : >1 <br /> all information contained in this application(including any accompanying schedule)and I further declare that i recognize m m O C <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Is- <br /> sue a permit. i further acce 11 liability which may be a result of the County of Burnett relying on this information I am m <br /> providing in this applic 'on. I agree to permit county officials charged with administering county ordinances or other m : :: <br /> ID <br /> rn 2 <br /> authorized person to ve acces o the above escribed pr ises at any reasonable time for the purpose of inspection. o <br /> (D <br /> SIGN HERE <br /> si ature o wrier or buildffig contractor) (date) a <br /> W i i <br /> ZONING ADMIN'STR OR ? <br /> 46 6% <br /> Nf�7110 NOO <br /> fTO Moo <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />