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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Adrnlnistrator -0 Z <br /> APPLICATION FOR LAND USE PERMITS ° <br /> r <br /> w Oti <br /> w <br /> t� 7 .y c <br /> OWTER � TELEPHONE J <br /> o a <br /> _ w <br /> MAILINGADDRESS losvg £ <br /> �7 e7o <br /> PROPERTY ADDRESS /141a � � I <br /> 7�C tv <br /> LEGAL DESCRIPTION(see tax receipt Z <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTUREP0 ADDITIONo <br /> TYPE OF PERMIT(S): a o <br /> FILLINGIGGJRADING ❑ CAMPI G UNIT El SUBDIVISION ❑ —"^"'^ Z A <br /> STRUCTURE/ADDITON USE: l! 0T. <br /> (Home/Cabin;Commercial Business; Bedroom; Deck; etc.) y (/•I <br /> BUILDING CONTRACTOR: m <br /> 7/JC0A5 &I <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR e <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. n , <br /> A <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p m <br /> T n <br /> f. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T Z� <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)ANC INDICATE m o `C A <br /> NORTH(N). C V, Q <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDINGS TO m <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHW c)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. F O <br /> S. 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., E PLANS Oo <br /> MUST BE SIGNED AND DATED BY THE OWNER. ro t <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN w o, <br /> NEEDED. 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 7S I <br /> CONDITIONS OF PERMIT: r .� <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 /> 6. a c m m n n F AT <br /> C= o <br /> A <br /> �' x 3 <br /> o c Cm o o _ <br /> 7. Z c o m � o o � � <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to theLhor <br /> f my <br /> i 4)2 i v : C <br /> knowledge and belle(lt is true,correct and complete. 1 acknowledge that I am responsible for the detail and cy of n a? A <br /> all Information contained In this application(including any accompanying schedule)and I further declare thatgnize m 5 E m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin In determining wto is- oiio <br /> sue a permit. Ifurther accept all liability which may be a result of the County of Burnett relying on this Infor1 amproviding In this application. I agree to permit county officials charged with administering county ordinancother <br /> authorized poguItt to have access to the above described premises at any reasonable time "0111. <br /> m D <br /> li <br /> SIGN H w n <br /> (signa of own building contractor) ( to) <br /> ZONING ADMINISTRATOR I>t ^ <br /> ut <br /> TOWNSHIP PERMITS MAY BE REQUIRED 13UFINETT CiOUN rY <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSU/$MING <br />