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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> CD APPLICATION FOR LAND USE PERMITS �. <br /> m O <br /> N <br /> 1 / C <br /> OWNER V -{-- C l fV TELEPHONE S/—'`t`3>—'7 h"Y/ <br /> MAILINGADDRESS �,�- $* lzas�y.ta� � <br /> ZI <br /> r � <br /> 0 <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE I� ADDITION ❑ O m o <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ '� <br /> 0 <br /> STRUCTURE/ADDITION USE: C�-�P <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) cn G <br /> ry � <br /> BUILDING CONTRACTOR: <br /> m <br /> CD <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. T <br /> O <br /> (AERIAL OR TOP VIEW) 0 a <br /> -n O Z <br /> ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. A v <br /> SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). U \ o <br /> SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m3 <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 /> SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO <br /> BUILDINGS, ROADS, LAKE, LOT LINES. ( Q <br /> INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. IN <br /> IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. 'o o <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P <br /> O 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT31 0 <br /> ISSUANCE. is's t <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. (A <br /> 3. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY r ,` <br /> PERMITTED. V <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER Q <br /> SETBACK AREA. <br /> 5. This structure to be used as private residential X co 0 r- D 0 D O -0 <br /> m cmo (Dafm <br /> 6. garage/storage only. Not to be used for human x 3 n 2 x a <br /> habitation. -ao" C y > > 3 <br /> 7. Z co . q <br /> o m :rnmr'� m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m _ r^ O <br /> PP ( 9 Y ) Y Y E G) C <br /> knowledge and belief it is true, correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of OQ' o ca " <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m mt7 <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- W <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 m : o <br /> providing in this application. I agree to permit county officials charged with adm' her <br /> authorized person to have access to the ave describe premises at any reason I o m a <br /> CD D <br /> CD n <br /> SIGN HERE <br /> (s' na_ttureo owner or contractor) NOV (date E 0 i <br /> ZONING ADMINISTRATOR l <br /> BURNETT COUNTY <br /> OocN„ ocWi� c�"'n �o <br /> TOWNSHIP PERMITS MAY BE REQUIRED ZONING <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> �l%cat ter, Kctictnf <br />