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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 . <br /> N � <br /> CD <br /> NI L� N <br /> OWNER ' ' 1 u-1 ` e TELEPHONE <br /> MAILING ADDRESS lq(j fj VCe <br /> PROPERTY ADDRESS 3 / ✓ �/ 5�>'tiC Q (tc� /V 1 <br /> LEGAL DESCRIPTION(see tax receipt) w l iy �s m V. 1� I t m <br /> 111 <br /> DWELL ING/BU ILDI NG n GARAGE/ACCESSORY STRUCTURE ADDITION ❑ (n ° <br /> TYPE OF PERMIT(S): C <br /> Ju <br /> FILLING/GRADING/❑ CAMP yG�U/NIIT-,❑I SU IVISSIIO'NT. <br /> ❑ �` <br /> STRUCTURE/ADDITIONUSE: �h l /H'�Y�;I lod F��I'I'!�(J ° <br /> 0 <br /> (H me/Cabin;Commercial B oom; Deck; etc.) m <br /> BUILDING CONTRACTOR: S t—o /� w <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81h X 11 SHEET OF PAPER. ANY INCOMPLETE OR m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T o CD <br /> TIZ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. A w <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). N o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m3 <br /> —:410ENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF ( o <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 Q <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. <br /> v � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN y» <br /> �. <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> 1 <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. <br /> 0 011=10 mCa * m <br /> CD CL CD X <br /> a m C y y 0 <br /> 7 Z y m 0 <br /> . (O <br /> o T c i M <br /> = Cnii m <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my �j a . ; C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of Ba a vein : 55 <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o mCDy <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 app1lion. I agree to permit county officials charged with administering county ordinances or other o <br /> authorized perso o h�e access a bov described premises at any reasonable time for the rpos of inspection. m o <br /> m � m <br /> SIGN HERE <br /> (signatu of ner o building contractor) (date) . a <br /> ZONING ADMINISTRATOR I 60n <br /> e <br /> fA di 63H� N <br /> N 01 N N O O <br /> (71 0 01 01 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUAN E <br />