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Office of Zoning Administrator - o 0 <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 0 0 <br /> APPLICATION FOR LAND USE PERMITS - <br /> I y <br /> !' r <br /> TELEPHONE 714 Q <br /> OWNER v <br /> MAILING ADDRESS <br /> h a C <br /> r <br /> 0 <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) WTD d� I(�I �Dln�1151 (7� t rJ r N�!�— t <br /> �( o <br /> DWELLING/BUILDING GARAGEIACCESSORY STRUCTURE ❑ ADDITION JdJ <br /> TYPE OF PERMIT(S): <"1 <br /> FILLINGIGRADING ❑ CAMPING UNIT ❑ UBDIVISION ❑ N <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; ClQmmercial Business; Bedroom; Deck; etc <br /> ..pp m <br /> BUILDING CONTRACTOR: L -4 <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. ,-p <br /> O a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n Z <br /> A m <br /> 1. ALL REQUIRED DIMENSIONS OR DIS ANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS (EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> NORTH(N). M 0 m <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO z <br /> CENTERLINE OF ROAD, (C) BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF 0 <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO S 01, <br /> BUILDINGS, ROADS, LAKE, LOT LINE S. <br /> 5. INDICATE IF A WALKOUT BASEMEN IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <br /> 6. IF SEPARATE PLANS ARE SUBMITT D BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR,ETC.,THE PLANS _. <br /> 0 <br /> MUST BE SIGNED AND DATED BY T E OWNER. p <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. <br /> Z <br /> THIS PERMIT IS SUBJECT TO ALL CONDI FIONS LISTED BELOW. ° <br /> CONDITIONS OF PERMIT: t/ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 1 <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREESND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALT RATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETMINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. a] 0r- > 0> <br /> p100 CD 00a :E m <br /> CD <br /> 6. v o'R om on 3 <br /> Z C m : : <br /> 0 N 21 m <br /> 7 : S2 <br /> : A <br /> I declare that this application (includm any accompanying schedule) has been examined by me and to the best of my C <br /> knowledge and belief it is true, correct nd complete. I acknowledge that I am responsible for the detail and accuracy of _ng schedule)and I further declare that I recognize m <br /> all information contained in this applica ion(including any accompanyi <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- o t7 <br /> ation I am <br /> sue a permit. 1 further accept all liabilit which may be a result of the County of Burp_ tkis IPfA ' <br /> application. 1 agree t per count officials charged with admim i c n �, n r i <br /> providing in this app' 9 y f' p n <br /> authorized person to have access to the ab a scribed premises at any reasonable i t pd$ D <br /> SIGN HEREd o <br /> ignat own or building contractor) <br /> r UPI: <br /> ZONING ADMINISTRATOR j20 LIl(Jg.�.--�- IIT1T7C1 <br /> ZONING <br /> TO NSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />