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Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator v L7 Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> N 0� <br /> N <br /> I C <br /> OWNER �P.l S �d e r,0 TELEPHONE <br /> o � <br /> I '�� PiY CLJ� s 163 " � <br /> MAILING ADDRESS 5 � O <br /> t,(/ C � <br /> CD <br /> CD <br /> PROPERTYADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) U� // (?Sh) fJ <br /> DWELLING/BUILDING IT GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ Q q o <br /> TYPE OF PERMIT(S): n I cL <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ �I/ a <br /> / p �J N <br /> STRUCTURE/ADDITIONUSE UA �.. � , ( Ute{(, (/�P O jd <br /> (Home/Cabin; Commercial Business;Bedroom;Deck;etc.)I ti <br /> BUILDING CONTRACTOR: <br /> 42 <br /> s� <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 61/]X 11 SHEET OF PAPER. ANY INCOMPLETE OR m <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> ,See, 0 c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p n11 <br /> _ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <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. o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO O <br /> BUILDINGS, ROADS,LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. a N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE PLANS 0 t <br /> MUST BE SIGNED AND DATED BY THE OWNER. O <br /> F <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z I <br /> CONDITIONS OF PERMIT: ° Q <br /> 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT O ._ <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 m r'- ODQO -0 <br /> 6. 3 nm X -1 <br /> 7. Z y m o N ' 3 <br /> P T M <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m _ A <br /> PP ( 9 Y ) Y Y <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of k; <br /> ,, d in C <br /> N' <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognizem m o v <br /> that this information 1 am providing will be relied upon by the County of Bumett Wisconsin in determining whether to is- <br /> sue a permit. I f rther accept all liability which may be a result of the County of Burnett relying on this information I am d <br /> providing in this pplication. I agr a to permit county officials charged with administering county ordinances or other m <br /> � . <br /> authorized perso to have access t the ove described premises at any reasonable time for the purpose of inspection. (D <br /> m o <br /> CD m <br /> SIGN HERE <br /> n : <br /> sign lure of ownMoullg contractor) (date) <br /> ZONING ADMINISTRATOR <br /> EA di fA EA � N <br /> N (TNN O O <br /> [T O (T (T O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />