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Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS E3 11 , <br /> to O 1�1 <br /> � (D <br /> OWNER �1Y a� I TELEPHONE �r \ J S 3 q"O 0) ov <br /> L1���111��11 l CD <br /> MAILING ADDRESS1 Z S � � ►J 7t :E <br /> r- <br /> 0 <br /> PROPERTYADDRESS (jp Ll '0 Tyt p� C,Alk , <br /> Q P <br /> LEGAL DESCRIPTION(see tax receipt)�� S� SYV — 3 O —� 1 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION c ° <br /> TYPE OFPERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑, SUBDIVISION ❑ 7 jf/jI�„ o <br /> STRUCTURE/ADDITIONUSE: <br /> (Home Cabin ommercial Business;B droom; Deck;etc.) U <br /> BUILDING CONTRACTOR: ZS <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> �l N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) DO <br /> 0 (D (l,n\ <br /> -n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). CCA 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 41 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF Q 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. �J <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 0 1 <br /> MUST BE SIGNED AND DATED BY THE OWNER. ° <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. <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. <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. l , _ i\ T/1 <br /> CEL coo `D M <br /> 6. CD C: _ 3 <br /> 7. Z m Tom : <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my C <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of <br /> (D cn : M <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o : m0 <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. I further accept all liability which may be a result of the County of Burnett relying on this information I am m <br /> providing in this application. gree to permit county officials charged with administering county ordinances or other o <br /> authorized person to have ac esj to the above described premises at any reasonable time for the purpose of inspection. m o <br /> CD m : <br /> CD <br /> SIGN HERE S' a <br /> (sla of o or building contractor) (date) <br /> ZONING ADMINISTRATOR <br /> d1 0 N <br /> K) N) <br /> TOW HIP PERMITS MAY BE REQUIRED <br />