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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator vO Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> rn O <br /> Vl <br /> OWNER TELEPHONE <br /> MAILING ADDRESS <br /> ll `� •010 f�Je o <br /> CD <br /> CD <br /> 0 <br /> 0 <br /> PROPERTYADDRESS P?Zi I <br /> LEGAL DESCRIPTIONt see tax receipt) <br /> \ <br /> ( p)� � C2�r g� n �SrJ <br /> 'g- p 4 a <br /> DWELLING/BUILDING 54 GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ 0 <br /> TYPE OF PERMIT(S): c� <br /> FILLING/GR <br /> j.\A <br /> �DING [I CAMPING UNIT [I SUBDIVISION <br /> 7•r ❑ a (\ <br /> STRUCTURE/ADDITION USE: f?�t o \ <br /> (' (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) ? � <br /> BUILDING CONTRACTOR: CD <br /> ' <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m - <br /> O <br /> C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p M <br /> n a <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n 0 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(Na)AND 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 m 3 <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF OQ Z) 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. * 4 <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> � f <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN 71 o ) <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z vqj <br /> CONDITIONS OF PERMIT: P <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT (C <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. W <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 Q d <br /> SETBACK AREA. <br /> 5. <br /> mco 0 r D O a 0 <br /> 0) f m <br /> 6. x9CD <br /> a � yam <br /> omC:WW 3 <br /> 7. Z C ri. N 0 : D O <br /> -n < m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m = °n 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 m n : cn • C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- CD <br /> in : t7 <br /> sue a permit. I further accept all liability which may be a result of the County of n I m v o <br /> providing in this application. 1 agree to permit county officials charged with ad s MCC i r m m <br /> o m : <br /> authorized person have access to the ove described premises at any reason I i o m <br /> m a <br /> D : <br /> SIGN HERE ba n <br /> sig tur of o building contractor) % �— <br /> ZONING ADMINISTRATOR <br /> COUNTY ��EA b9 d1 fA�N <br /> �ONCTW WNO <br /> TOWNSHIP PERMITS MAYBE REQUIRED ZONING <br /> THIS PERMIT SHALL EXPI EON A FROM DAT OF ISSUANCE <br /> f`rrnI -t- (trot lM!, ul I - <br />