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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m o 0 <br /> APPLICATION FOR LAND USE PERMITS .y O <br /> h91 <br /> 111 II , 1mIor� m <br /> I � <br /> �VI (OWNER � <br /> w_ <br /> Q n m <br /> MAILING ADDRESS lP S 17 Cy,())1�� r` 1� I SI yl WL Sy �J�2 0 <br /> 0 <br /> PROPERTY ADDRESS <br /> Se c-+[o✓� 2-3 S w S w F SL sw pa r` e <br /> LEGAL DESCRIPTION(see tax receipt) 3e C"1-1.�I✓) 2(0 Nw r4 w Pa V4 Of (D <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ® ADDITION ❑ 00C <br /> TYPE OF PERMIT(S): cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ < t*, <br /> STRUCTURE/ADDITION USE: ;Bun k' 4 a U5 E— p�t! Q 1 c-f 1'6 Gc � GtCC PSS Qf C�' u S?� <br /> (Home/Cabin;Commercial Business; edroom-; -Deck;etc.) C <br /> BUILDING CONTRACTOR: se <br /> C <br /> CD <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 /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> n <br /> ?t o z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m �o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> Co <br /> 3. SHOW D MNORTH )ENSIONS 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 ( 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. o I <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR,ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. c f <br /> o <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 ' <br /> CONDITIONS OF PERMIT: <br /> U <br /> I '1 <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 /> m ymo m aF rrn <br /> 6. m 3 am F A <br /> -6 m C y N O j <br /> 21 <br /> 7. O N Z < 7 : M <br /> = W: O <br /> I declare that this application (including any accompanying schedule)has been examined by me and to the best of my <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of w avi: <br /> CL u, : <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m : O mm <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- CD <br /> sue a permit. I further accept all liability which may be a result r ying on this information I am ° w <br /> providing in this application. I agree to permit couofficials Yg��wl hi admIr�isl j'ng e¢a ty,'ordinances or other <br /> authorized perso to have acce s t t e above described premi fah r 6.onalalb t144iie ttitktNN Urpose of inspection. w ': o <br /> nty <br /> 6 ? <br /> SIGN HERE �' w <br /> i (signature of owner or building contra / (d te) a '. <br /> ZONING ADMIT RIATOR f(11 1�7I3n1G0fl_ URN TT GOUNTY <br /> J ONING rou, " , N <br /> N N N N O O <br /> Cn0 (n Ut00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />