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Burnett County 7410 Co.Rd. K,No.102,Siren,WI 54872 Office of Zoning Administrator - o a <br /> APPLICATION FOR LAND USE PERMITS <br /> N O <br /> S � u�� �/ T 6 5/033` <br /> OWNER TELEPHONE. � M <br /> r`` �/ m <br /> MAILING ADDRESS �L&f ��('�� �' ��^� r� Clf-�►.���sY� /I.tJ 533/ r <br /> PROPERTY ADDRESS -2_70 LD Al L.#4=6 <br /> r+ V ;> 7S� <br /> LEGAL DESCRIPTION(see tax receip G Z qo �� f yZ/FG I- I-YG w d F <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ :�� a c 0 <br /> TYPE OF PERMIT(S): $ <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) m <br /> SGFBUILDING CONTRACTOR: <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 834 X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 9 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 $ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <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. P <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO * C> <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. v ? r`- <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. O <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <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. C <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY �7 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> BACI�AREA. <br /> 5 <br /> �� R 00R ElM : M <br /> 7. <br /> 0 / <br /> I declare that this application (including any accompanying schedule)has been examined by me and to the best of my c� <br /> =rnE i <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of ? m c�i i in i C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m ii o G <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <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 i o <br /> m : mE <br /> authorized person to have gposs to the above described Memises at any reasonable time for the purpose of Inspection. m i o <br /> m <br /> m m : <br /> SIGN HERE <br /> C : <br /> (Sig re of owner or budin on aacctorr),� (date) n <br /> ZONING ADMINISTRATOR c� W 1��"1/N C� ^ '• {iq E y� <br /> ��p�� 0NN00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED �./ <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />