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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 3 <br /> (,Z lT 7� 7 r�' o �j•' V� <br /> OWNER TELEPHONE 1 <br /> m <br /> MAILING ADDRESS-P111...� �, -(/\ 0 ScL�, Y'tAl }'1 13�J- /� o <br /> PROPERTY ADDRESS !!��(-- t I, ) <br /> 7 <br /> LEGAL DESCRIPTION(see tax receipt) �'�C. r (�--'I p� C oc) <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ rn .�L• <br /> TYPE OF PERMIT(S): C ' a1r^•�S <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> W <br /> /� � /�) m <br /> STRUCTURE/ADDITION USE: S /t-� �-�T1' (xQlQty �Cl j}� o <br /> (Home/Cabl>�Commercial Business; Bedroom; Deck; etc.) rn �� <br /> m <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> z <br /> DIRECTIONS FOR PLOT PLAN DRAWING, (AERIAL OR TOP VIEW) O <br /> n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE IT <br /> NORTH(N). o <br /> n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m B <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF a <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. F 1 <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN (\jy <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o \ Q <br /> CONDITIONS OF PERMIT: ` '1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. O (° <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ^ d <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 /> A W 0 D O D O -0 <br /> m m m m n f m <br /> 6. 3 n m F n m A <br /> a' am Cy .`" og3 <br /> 7. Z c H m o p 1 <br /> O m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m ? �' i O <br /> PP (� 9 Y ) Y Y <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of �' m ' <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize l m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to <br /> is- `� <n <br /> sue a permit. I further accept all liability which may be a result of the County of Burne I in on this inf r I d o <br /> providing in this application. I agree to permit county officials charged with admin' i c �' m <br /> authorized person to have access to the above scribed premises at any reasonab f h s i m <br /> T n : <br /> � D <br /> SIGN HERE n— <br /> i at owner r AR i contractor) (ctRe <br /> ZONING ADMINISTRATOR <br /> BURNETT COUNTY— C, <br /> e n » <br /> �fA EA fA fA � N <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> ZONING c, <br /> THI S�ALLlXP R O EI R ATE OF SU N E <br /> )0-) M � <br /> �kf <br />