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Burnett County 7410 Co.Rd. K,No.102,Siren,WI 54872 Office of Zoning Administrator -0 o° o <br /> APPLICATION FOR LAND USE PERMITSCD <br /> .so <br /> J <br /> OWNER L - �U/✓1 L' TELEPHONE <br /> W a <br /> pian / m <br /> MAILING ADDRESS O <br /> PROPERTY ADDRESS LA) <br /> a <br /> CD <br /> LEGAL DESCRIPTION(see tax receipt) <br /> CD <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION _(/> <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ < <br /> STRUCTURE/ADDITION USE: t-Dt e/!•'1 ? Ah7l <br /> (Home/Cabin;Commercial Business; Bedroom; Deck; etc.) (n <br /> BUILDING CONTRACTOR: <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81h X 11 SHEET OF PAPER. ANY INCOMPLETE OR T <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED, p <br /> M <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 u <br /> 71 lEi Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES 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 <br /> NORTH(N). y <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 1 Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 0 <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO (9 <br /> BUILDINGS,ROADS, LAKE, LOT LINES. f,} <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <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 f <br /> v � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN q <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1 � <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT i n <br /> ISSUANCE. fUn' <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 /> 6. � 3 am Fam <br /> Z y W O y O O <br /> 7. O T� i m <br /> 1 declare that this application (including an accompanyingschedule has been examined b me and to the best of m —�^ 0 <br /> PP ( 9 Y ) Y Y E C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m <br /> all information contained in this application(including an accompanyingschedule and I further declare that I recognize m$ m <br /> PP f 9 Y ) 9 �jJ �: � <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- M <br /> sue a permit. I furthA accept ll liability which may be a result of the County of Burnett relying on this information I am ; m <br /> providing in this a I atio gr to r it county officials charged with administering county ordinances or other o <br /> authorized person ave ss o e described premises at any reasonable time for the purpose of in action. m o E <br /> CD <br /> �_1 .� <br /> SIGN HERE 7 (/ d' M <br /> (signature of owner or building contractor) (date) o. <br /> ZONING ADMINISTRATORE <br /> � (ft'.S <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE � h, <br />