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Burnett County 7410 Co.Rd. K,No. 102,Siren,WI 54872 Office of Zoning Administratorm o° a <br /> APPLICATION FOR LAND USE PERMITS <br /> y O <br /> N <br /> C <br /> N _ <br /> OWNER TELEPHONE <br /> m o <br /> MAILING ADDRESS <br /> o m <br /> PROPERTY ADDRESS 1 <br /> LEGAL DESCRIPTION(see tax receipt) IpI � <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE pJ ADDITION ❑ a N o <br /> TYPE OFPERMIT(S): c ' <br /> FILLING/GRADING ❑ CAMPING UNIT ❑1 SUBDIVISION ❑ <br /> CIL <br /> STRUCTURE/ADDITION USE: J rd �� AR�t/ 3u X log, r- <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) rn <br /> / w rb <br /> BUILDING CONTRACTOR: �e s ! a n( c/("f GYI� 2' <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81h X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> M <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 O <br /> 'n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m �( 7 Z D <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATEEt <br /> NORTH(N). N o <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 1Z <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. `2 <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. tS N bb <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 o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN D» g J <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT > 1 ' <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 /> $ mm00Aafm <br /> m cm, m o <br /> Z %nrpo1 <br /> 7. Ifo <br /> a m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m —^� D <br /> PP ( 9 Y ) Y Y 0 C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of E mFn <br /> o ^' : � . 9 <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m o m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Is- ; <br /> sue a permit. I further accept all liability which may be a result of the f Burnett relying on this Information I am m <br /> providing in this application. I agree to permit county officials ch finances or other n <br /> authorized person to have access to the above described premise t e t e of inspection. m c <br /> m i m <br /> SIGN HERE 7 O <br /> (signature of owner or building contractor) JUL 020 <br /> to) n <br /> ZONING ADMINISTRATOR1W fo <br /> BUHNE <br /> COUNTY loinNO <br /> ro 0 ro O 0 0 <br /> n LQ� I �-(�I TOWNSHIP PERMITS MAY BE REOL"NG <br /> 11 r t <br /> HIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />