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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS <br /> o <br /> y r�� <br /> C <br /> OWNER TELEPHONE 7 3_ y3Y_ v 3 C19o V.1 <br /> m <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS ��� �$ ���� �wr� ���5 Q �rL�cw UI► v, o r <br /> I <br /> J b''-IB37 <br /> LEGAL DESCRIPTION(see tax receipt) OSM V. <br /> ❑ 0 tni' <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION G C ° <br /> C � <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITION USE: L d.V-a%r%. 0 <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) d <br /> 2. <br /> BUILDING CONTRACTOR: � .mac.r c 0, 9� o ti <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 71 SHEET OF PAPER. ANY INCOMPLETE OR -n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> TJ N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O cDD <br /> n <br /> 7. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m 1D <br /> C � 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 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 C9 <br /> BUILDINGS, ROADS, LAKE, LOT LINES. W <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. ^- N -C <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE PLANS li <br /> MUST BE SIGNED AND DATED BY THE OWNER. 0 <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN ° ) <br /> NEEDED. O <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 <br /> ISSUANCE. b <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 9 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 0r,0Qvv <br /> m <br /> 6. 3amOO m <br /> o <br /> C:CD <br /> N CD o 1 <br /> 7. o T ;! T <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my oo ,, 0 a C <br /> /�l: <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of i n d, <br /> CLE <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize (D o v <br /> that this information I am providing will be relied upon b the County of Burnett Wisconsin in determining whether to is- <br /> P 9 Y tY 9 O <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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to h ve access to the above described premises at any reasonable time for the purpose of inspection. CD <br /> o <br /> CDM <br /> m <br /> SIGN HERE J a a a <br /> (signature of ownerorbuilding contractor) (date) <br /> ZONING ADMINISTRATOR �(1� 1 1I F_nv, <br /> NSTN NOO <br /> r� (T O0 UiOO <br /> TOWNSHIP PERMITS MAY BE REQUIREDVNQ_ <br />