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Burnett County 7410 Co. Rd. K, No. 102, Siren,W154872 Office of Zoning Administrator *D o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> N O Q <br /> w <br /> p � <br /> OWNER / � / TELEPHONE ' //� �4�c� �3S/��j p I <br /> MAILING ADDRESS <br /> r � <br /> PROPERTYADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) r✓Sh� u p a?r C(ay 1 o f-S ��1J <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ O c 0 <br /> TYPE OF PERMIT(S): Cna <br /> FILLINGIGRADING ❑ CAMPING UNIT ❑ SUBDIVISION ( N. <br /> STRUCTURE/ADDITION USE: '- 31 '7 ° <br /> Y `r <br /> 0 <br /> (Home/Cabin; Comnlprcial Business; Bedroom; Deck; etc.) v p— <br /> BUILDING CONTRACTOR: <br /> -a <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. 0 = 1 <br /> � � O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 3 A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATECD <br /> NORTH(N). 3 <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. ° <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 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 0 �U <br /> MUST BE SIGNED AND DATED BY THE OWNER. 'a f 1 <br /> C3 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN ° ° <br /> 41 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. Dq C4 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. "\ (Z's („ <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY y hJ) <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAININ(WAI I G FTC At I QWFD WITHIN THE REQUIRED WATER C7 <br /> SETBACK AREA. This structure to be used as private residential <br /> 5. ara a/stora a only. Not to be used for human r <br /> g g g Y CD m () ronov <br /> CD 6 habitation. F 3 n m F CD a m <br /> o m Co 3 <br /> 7. o m y 'n . o .'0 <br /> = v) : m <br /> I declare that this application (including any accompanying scneaule) nas peen exammea oy me ano ro me nest of myO <br /> J G)_ <br /> I knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail andaccuracy of n <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize im <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- ~ 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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other j <br /> authorized person to have access to th abov described premises at any reasonable time for the purpose of inspection. T n <br /> a : <br /> SIGN HERE O�` I - ®3 Fs a <br /> �gn owner or II contractor) (date) <br /> ZONING ADMINISTRATO <br /> �-rA<f9 ffl EA 469N <br /> O N Cll W W N O <br /> TICZ7SHIP PERMITS MAY BE REQUIRED o u o cn cn n o <br /> THIS PERMIT SHALL EXPIRE ONE YEAR F OM DATE OFlSSUANCE <br /> (na t pec( w t�h i ems. ler f� Pi <br />