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ON COMPUTER/SCANNED <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o° o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> F o <br /> N <br /> C <br /> ID <br /> (J�� / d <br /> OWNER/ TELEPHONE / /Co�_Yyyp - <br /> MAILING ADDRESS �99Z Z12 /✓A O�� ,ff�s� SSG ShyCD <br /> CD <br /> PROPERTY ADDRESS ] <br /> LEGAL DESCRIPTION(see tax receipt) tCD <br /> d a �. <br /> DWELLING/BUILDING ElGARAGE/ACCESSORY STRUCTURE ADDITION �^ a 0 <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <. <br /> STRUCTURE/ADDITION USE: �. <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) cn <br /> i r i �� a beGf�• o <br /> BUILDING CONTRACTOR: <br /> m <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81A X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 r <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> rZI N ` <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 n <br /> n <br /> T1 6 Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m R <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS (EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> C a <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 I o <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. ,J 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. 'o O W <br /> D � I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN ° C ^ <br /> NEEDED j <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o �'J <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. C), <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER �' O <br /> SETBACK AREA. <br /> 5. <br /> CID C° v u r, Ca : m <br /> 6. m xBam n <br /> Q (D C y N O J 3 <br /> 7. O 6 fn T m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m _ <br /> PP ( 9 Y 1 Y Y C <br /> knowledge and belief it is true, correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of C <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize m rn <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- (/J 6/ cn <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 o <br /> providing in this application. I agree to permit county officials charged with a e ' ther ? d <br /> authorized person to have access to the above described premises at any reasqq r ion. T <br /> a : <br /> m Di <br /> SIGN HERE Com ^"— a <br /> (signature of owner or building contractor) Nov R ) I . <br /> ZONING ADMINISTRATOR �3TOU <br /> aSs`�y `1-2a-DL) aNX36 BURNETT COUNTY Go o <br /> TOWNSHIP PERMITS MAY BE REQUIRED ZONING v <br /> THIS PERMIT SHALL EXPIRE ONFROM DATEOF ISSUANCE tV%OUk � iSotl <br />