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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o° o <br /> APPLICATION FOR LAND USE PElfCD <br /> kf MPUTFR/ . <br /> �/` t- #EZi1S��1 /L �SCcLtI �']C 7 p (�S�:i4�N <br /> i�1 1� TELEPHONE / , D �p- cl Z�C a <br /> OWNER f ��1 Q� o <br /> 9 rot li cf,45 {cr; °MAILING ADDRESS (!j L� //"1L � F <br /> PROPERTY ADDRESS j !���- 1 t ne '2 P J'vtnb kY 14 MU N o <br /> LEGAL DESCRIPTION(see tax receipt) C <br /> DWELLING/BUILDING GARAGE/ACCESSORYSTRUCTUREX ADDITION ❑ "C rn <br /> TYPE OF PERMIT(S): a <br /> F: ' CAMPING UNIT El SUBDIVISION ❑ <br /> STRUCTURE/ADDITIONUSE: HQrne— <br /> (Hom Cabin;C m�merr+ciall Business; Bedroom; Deck; etc.) C <br /> BUILDING CONTRACTOR: <br /> L � S <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> M 41-, <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) a <br /> ?1 6 Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m M <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). N 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO m o <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. 9 <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO O <br /> BUILDINGS, ROADS, LAKE, LOT LINES. --H <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N O <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. 0 <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY-BE DONE WHEN <br /> NEEDED. o <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. j o <br /> CONDITIONS OF PERMIT: OR 2 C3 2 cS <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYSIf, ERMI►►TTT " J; <br /> ISSUANCE. 7 r ? OS <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHOR Co f p <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY /NG ' Y ` � d <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER C� <br /> SETBACK AREA. <br /> 77 CD W 0 � D � m <br /> 6. m 3 o m x m <br /> m C � 0' 3 <br /> 7. o �ii`< <br /> = cn m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my i7 c C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m <n <br /> all information contained in this application (including any accompanying schedule)and I further declare that I recognize co E : o mt7 <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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized perso to have access to the Above described premises at any reasonable time for the purpose of inspection. o <br /> CD <br /> CD <br /> SIGN HERE <br /> (signatureof ovQolrior buildin ntractor) (date) a <br /> ZONING ADMINISTRATOR <br /> n <br /> � <br /> m� oo <br /> �� �M TOWNSHIP PERMITS MAYBE REQUIRED S I <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE d !" <br />