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Burnett County 7410 Co.Rd. K,No.102,Siren,WI 54872 Office of Zoning Administrator - o° o <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNERIlJ1llrr <br /> MAILING ADDRESS <br /> 1 <br /> o <br /> PROPERTY ADDRESS6 <br /> a <br /> LEGAL DESCRIPTION(see tax receipt) 4 t°� /�/ / w m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ O, rn <br /> TYPE OF PERMIT(S): r v <br /> FILLING/GRADING ❑ CAMPING UNIT ❑� SUBDIVISION El \< , <br /> STRUCTURE/ADDITION USE: 5 o Y'C'e 5 xcc� 149 ' Y/a I <br /> ` ° (� <br /> (Home/Cabin;Commercial Business; Bedroom; Deck; etc.) cn i <br /> � m <br /> BUILDING CONTRACTOR: cJ r e <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> M N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 o <br /> :9 Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). CO) o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO 1713 <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. 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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <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. YM o f r <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATI » <br /> NEEDED. / <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. ✓q l o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMITVE� ZD"' <br /> ISSUANCE. Zo C(]��,_ I <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. / <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY G G <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> m 00 00 CL M <br /> 6. c 3 am yam <br /> m <br /> 9 m C,N„ <br /> y N O <br /> 7. <br /> P Tom . M <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m —�^ O <br /> PP (• 9 Y ) Y Y L�� C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of R »CL N <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 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- ' <br /> -Ci i G>i i <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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o ' <br /> authorized person to have accp&s to the 0,9,ve described premises at any reasonable time for the purpose of inspection. <br /> : m : U) <br /> -n <br /> w <br /> SIGN HERE � <br /> ( n ure of r or building contractor) (date) °• i <br /> ZONING A(MINISTRATOR 4 44 <br /> t�d +vb ) ' N <br /> JY1rn,l � U- �-� o � <br /> �t/ � oo <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> ��L <br /> 0-0-A"iHIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />