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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 G) z <br /> APPLICATION FOR LAND USE PERMITS <br /> r W <br /> rn O uv <br /> y <br /> C <br /> N <br /> C d <br /> OWNER � O r..� TELEPHONE <br /> e/ O <br /> MAILING ADDRESS <br /> 911 51- --11 rte- C-14 <br /> r <br /> o <br /> PROPERTY ADDRESS \C`y_l ,e S C� J P C O W e'r L�l �Q 61 Q� <br /> LEGAL DESCRIPTION(see tax receipt) T� 9j { <br /> _ OJT OT er- IO -q0-- tq �` �m tG <br /> R�q'77 tp <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION I/J� ` cn o <br /> TYPE OF PERMIT(S): Q C D <br /> FILLING//GRADING ❑ CAMPING UNIT ❑ tSUBDIVISION ❑ � a <br /> STRUCTURE/ADDITION USE: t0. r ZEo <br /> (Home/Cabin, Commercial Business; Bedroom; Deck; etc.) rn <br /> m <br /> r � <br /> BUILDING CONTRACTOR: rh 1i-S111r\ Ny�o .tni <br /> C <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8Yz X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m <br /> Z7 C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p m <br /> n n <br /> -n z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO m o <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 <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. o } <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> f <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z C b <br /> CONDITIONS OF PERMIT: <br /> 0 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT w <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 1 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY d <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER r <br /> SETBACK AREA. <br /> 5. <br /> CD m 0 r D O f m n 0 -0 <br /> 6. m X3 'a � <br /> omcm " oEi3 <br /> 7. Z Cn, m0 <br /> 9 m -n � [ 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. I acknowledge that 1 am responsible for the detail and accuracy of i " <br /> all information contained in this application (including any accompanying schedule)and I further declare that I recognize C C m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- ° rn <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 I: nO o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to ha access to the above described premises at any reaso on11 U . <br /> Tt n <br /> D : <br /> SIGN HERE a <br /> (sig ature of owner or building contractor) (date) p�' I o <br /> ZONING ADMIN S ATOR V ( I n l Q(> i <br /> Vi Vi fA EA- N <br /> TOWNSHIP PERMITS MAY BE REQUIREDBURNETT COUNTY a o v o v v n o <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROJM DATE OF ISSI$)" <br />