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_ ON COMPUTER/SCANNED <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v 0 z <br /> APPLICATIO FOR LAND USE PERMITS <br /> tj ° <br /> OWNER TELEPHONE 7/ , - <br /> MAILING ADDRESS / /� a O <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) /Q 3 C� -C ( <br /> CD <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION El <br /> TYPE OF PERMIT(S): lJ ' D <br /> 4 <br /> FILLING RADING ❑ CAMPING UNIT ❑ SUB ION n <br /> STRUCTURE/ADDITION USE: !(. / 'J� / L U� 0 9�5 <br /> (Home/Cabin; C,2mmekial Bu ' s; Bedroom; Deck; etc.) rn <br /> BUILDING CONTRACTOR: .� v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O Q ' <br /> -n z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 3 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS (EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m 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 m 3 <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. 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. <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o t <br /> CONDITIONS OF PERMIT: G <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT r 1 <br /> ISSUANCE. w <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 O <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> cn c n) v 0 cn o f m <br /> 6. m x3 c. m � acD � <br /> a Zr m C 0 <n o <br /> ° <br /> 7. Z c n c° -t <br /> o m -n <br /> = cn 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 G2 v : C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application (including any accompanying schedule)and I further declare that I recognize m • : . my <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- `� cn <br /> G) = : <br /> sue a perri}iE- further acce all liability which maM- ed <br /> esult of the County of Burnett relying on this information I am ( {` ° <br /> providin m thi application. gree to perm�t c icials charged with adm'n' v `D <br /> authoriied per to h ve c to the above d sremises at any r asonab Mio he o s i CD o <br /> m <br /> CD CL <br /> m D <br /> SIGN E '• ' a <br /> ( 9 ► JUN 2(2 U5 ° <br /> si aOTow <br /> o ui rn contractor t <br /> ZONING ADMINISTRATOR <br /> BURNETT COUNTY C1t W�'Cn N r) N <br /> O N W O <br /> TOWNSHIP PERMITS MAY BE REQUIRED ZONING O cn o a, <n cn o <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />