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Burnett County 7410 Co.Rd. K,No.102,Siren,WI 54872 Office of Zoning Administrator -U o 0 <br /> APPLICATION FOR LAND USE PERMITS _. <br /> r <br /> N O <br /> OWNER ��� R rNri TELEPHONE /SZ— 93 y _ '7Y11J o <br /> m <br /> MAILING ADDRESS <br /> 0 <br /> ( 0 <br /> PROPERTY ADDRESS 3 g Lq 2 <br /> LEGAL DESCRIPTION(see tax receipt) LbCs 3 3.) l/a_ CD <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION �o� p> <br /> TYPE OF PERMIT(S): Cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ CL <br /> Sr1 A0 r A 13 �45 N <br /> STRUCTURE/ADDITIONOSE: tPL�/y � <br /> �` (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) d <br /> BUILDING CONTRACTOR: Pk <br /> 2. <br /> E-Wr Jµ w <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 835 X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m <br /> O CQ • <br /> y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O CL <br /> �y. <br /> :I o I Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m D <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE ry� <br /> NORTH(N). U) o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m s <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF �/'( <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. , 1 <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 I <br /> v � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN q <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: o <br /> O , <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT N <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. O <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 /> (/ SETBAC�A. <br /> 33 0m Wm <br /> m0Ca � M <br /> 6. m 3o (OD Oxa m <br /> - m Cy y o <br /> 7. <br /> Z @ 'OD <br /> ° m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m – ` O <br /> PP ( 9 Y ) Y Y G>2 ; C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of w ° <br /> all Information contained in this application(including any accompanying schedule)and I further declare that I recognize m m m <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. 1 further accept all liability which may be a result of the County of Burnett relying on this information 1 am <br /> i <br /> providing in this app' a 'on. I a e to permit county officials charged with administering county ordinances or other E o <br /> authorized person td hgA a9d4slifft the above described premises at any reasonable time for the purpose of inspection. mc <br /> m <br /> SIGN HEREEu o <br /> (signator caner or building actor) (date) <br /> ZONING ADMINISTRATOR <br /> 69' ro <br /> p SHIP PERMITS MAY BE REQUIRED 1 � <br /> 7- THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE t' <br />