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Burnett County 7410 Co.Rd. K,No. 102,Siren,WI 54872 Office of Zoning Administrator - 0 0 <br /> CD APPLICATION FOR LAND USE PERMITS . <br /> OWNER A R 14 ks IJA.)b TELEPHONE 9S�2 83 I—p s 6 g w e <br /> �� S X3? <br /> MAILING ADDRESS O� � 1 99r# S <br /> CD <br /> PROPERTY ADDRESS 2987,5 S ,N6 ,[JRJVE WE1{�g Zjl<( �/! 5Y83 <br /> .n <br /> LEGAL DESCRIPTION(see tax receipt) rn <br /> DWELLING/BUILDING ❑ GARAGEIACCESSORY STRUCTURE ❑ ADDITION ❑ rn 0 <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> f rn <br /> STRUCTURE/ADDITION USE: jo C IZ 0 <br /> (Home/Cabin;Commercial Business; Bedroom; Deck; etc.) m <br /> BUILDING CONTRACTOR: <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'h X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m jp <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). y o <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. <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO I d <br /> BUILDINGS,ROADS, LAKE,LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. bq <br /> ly 1 <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 f <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. 0 m w ID I'n f m <br /> 6. m � a� xzDM <br /> ID C <br /> 7 Z N <br /> . <br /> o -n� . m <br /> �i <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c : C <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of n <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m c mt7 <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- i <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 ; ro <br /> providing in this application. I agree to a it county officials charged with administering count ordinances or other �' <br /> P 9 pP 9 P tY 9 9 Y E S E <br /> authorized perso to a acce s to the ove-described premises at any reasonable time for the purpose of inspection. m o <br /> CD � I <br /> SIGN HERE d' <br /> (signat�f owner or building contractor) (d te) a i <br /> ZONING ADMIN 1 TOR /, <br /> /qy- - fA fA fA(fl CD N <br /> ��(( 69 NNOO <br /> m��� �a_� `TOWNSHIP PERMITS MAY BE REQUIRED <br /> ��b-A s� THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />