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Burnett County 7410 Co.Rd. K,No.102,Siren,WI 54872 Office of Zoning Administrator CD o ° 0 <br /> APPLICATION FOR LAND USE PERMITS CIO <br /> CD <br /> N O W <br /> N S- <br /> d <br /> OWNER TELEPFIONE 0 <br /> _ o <br /> O <br /> F <br /> MAILING ADDRESS s(1 <br /> r CD <br /> r/ 0 <br /> PROPERTYADDRESS0I � 1J � L� <br /> ' r <br /> LEGAL DESCRIPTION(see tax receipt) I c— y®—/`i 1 . 1rn <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE L ADDITION ❑ c o. <br /> v <br /> TYPE OF PERMIT(S): o <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ N <br /> STRUCTURE/ADDITIONOSE: <br /> Cis-n ) Z X I h <br /> (Home/Cabin; Commercial Business, Bedroom, Deck,etc.) w <br /> BUILDING CONTRACTOR: 12 Vt <br /> v <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m0 y. < r <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 6 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n a <br /> -n v Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m W <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE rn c <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF pO c <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. W <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. o Cb <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS 2, o <br /> MUST BE SIGNED AND DATED BY THE OWNER. .0 <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. 1 <br /> Z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: 4 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. OrDaDOV <br /> CD <br /> � °10) 8CDa� rn <br /> fP - S <br /> 6. -o m y 00 <br /> Z <br /> 7. o T'� i i m <br /> �� E ` O <br /> 1 declare that this application(including any accompanying schedule) has been examined by me and to the best of my G)c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of a Ei m <br /> v <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that 1 recognize .� ' m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> sue a permit. 1 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 o . <br /> m: <br /> authorized pers n to have access to the above described premises at any reasonable time for the purpose of inspection. o <br /> m . m <br /> SIGN HEREn <br /> (signature owner or Ing contractor) <br /> �(date) <br /> ,� <br /> ZONING ADMINISTRATOR y, 1 N <br /> cNii o cn o <br /> LTOWNSHIP PERMITS MAY BE REQUIRED <br /> �;� THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />