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Burnett County 7410 Co.Rd. K,No. 102,Siren,WI 54872 Office of Zoning Administrator - 0 0 <br /> APPLICATION FOR LAND USE PERMITS . <br /> N <br /> TELEPHONE 7 C U 6 t 7 w \ w <br /> O <br /> MAILING ADDRESSCD <br /> © ^ SI1 f <br /> PROPERTY ADDRESS 1"l 2 W ObA Q T <br /> LEGAL DESCRIPTION(see tax receipt) � rid 0 U) rn <br /> CD <br /> (� a (� <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE El ADDITION Elrn o <br /> TYPE OF PERMIT(S): 1 n <br /> FILLING/GRADINJ& CAMPING UNIT ❑ SUBDIVISION ❑ 1 <br /> N <br /> STRUCTURE/ADDITIONUSE: L]}10 M U <br /> (Home/Cabin;Commercial Business; Bedroom; Deck; etc.) 0 <br /> 2.BUILDING CONTRACTOR: - G, <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n 3 C <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p 57" 41, <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 o <br /> ?f 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 /> CD <br /> NORTH(N). W 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 �Q c <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 Q) <br /> BUILDINGS,ROADS, LAKE,LOT LINES. �� C <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N Li <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS QOq <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> v � <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. o O <br /> CONDITIONS OF PERMIT: O <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. w <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY rW <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER W !� <br /> SETBACK AREA. <br /> 5. pnsl -fe 4 - 00-0s vK <br /> m nnm0CDaf m <br /> 3 a o o RS <br /> 6. -a N C y y J C <br /> Z N m 0 _� <br /> 7. 0 I`G 2J <br /> � U) <br /> I declare that this application (including any accompanying schedule)has been examined by me and to the best of my O <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of w 0 E v,:: C <br /> i CL u+ : <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m O m0 <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. 1 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 applica ion. I agre o permit county officials charged with a i r' r her f o <br /> authorized rson to ha a cce o e bove described premises at any reasq I f p o i n. <br /> m m o <br /> CDSD <br /> m : <br /> SIGN HERE _ b' <br /> (signature of owner or buildin contractor) <br /> APR n <br /> ZONING ADMINISTRATOR ( Flan t V CWJ <br /> BURNETT COUNTYN N ro ro o 0 <br /> C� <nocnu, o <br /> TOWNSHIP PERMITS MAY BE REQUIRED ZONING C� <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />