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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 3 <br /> o <br /> CD <br /> ryCL <br /> OWNER ( / F�( `I f / �J/j�! TELEPHONE - 7�� O� o <br /> m <br /> MAILINGADDRESS es rCi - �qCS /Y rf f <br /> i 0 <br /> 0 <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION(see tax receipt)Pa t L) J -39_ m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ W O <br /> TYPE OF PERMIT(S): 1 Q <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ,y❑ r n <br /> STRUCTURE/ADDITION USE: y (J-) 1 D o <br /> (Home/Cabin; Commercial Business; Bedroom; Dec ; etc.) rm n <br /> BUILDING CONTRACTOR: m <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> W <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> T O 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 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m a <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. <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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 0 1 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 2 <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> v M <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <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 /> X W d r > 0 Da v -0 <br /> 6. m a=ct nm xam .� <br /> 7. Z G N N O O <br /> O N <br /> 1 declare that this application (including an accompanyingschedule has been examined b me and to the jn <br /> PP ( 9 Y ) Y Y � : C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and of w' n <br /> CL all information contained in this application(including any accompanying schedule)and I further declare thatize m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whis- <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this inform m o <br /> providing in this application. 1 agree to permit county officials charged with administering county ordinancerwauthorized person to ve cces t above describ d pre s at any reasonable time for the purpose of n. CDm<D a i <br /> SIGN HERE • d' - <br /> (signatuLs.9f owns r building contractor) (date o <br /> ZONING ADMINISTRATOR <br /> O N CST M WN O <br /> 0010O <br /> TOWNSHIP PERMITS MAY BE REQUIRED (T <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />