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ON COMPUTEWSCANNED <br /> 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 /> C <br /> (av7a'lot C --Pa <br /> OWNER TELEPHONE a CD <br /> C�, �- � <br /> 5 '?5` w <br /> MAILING ADDRESS yir�e -P_ O <br /> r � <br /> 0 <br /> PROPERTY ADDRESS A(�� ~ <br /> t l „ <br /> \LEGAL DESCRIPTION(see tax receipt) ?j L' J —� <br /> �Lj <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ c 0 <br /> TYPE OF PERMIT(S): v <br /> FILLING/GRADING � CAM 1NG U SUBDIVISION �� � °' <br /> X _ <br /> STRUCTURE/ADDITION USE: <br /> N <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) rn <br /> w <br /> BUILDING CONTRACTOR: <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> �QIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> � o Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m X <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). C a <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO rt1 0 <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. p <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 0 L <br /> MUST BE SIGNED AND DATED BY THE OWNER. 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN y. <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 0 9� <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. h <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY p` <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5.� ( m w w 0 CD I Daum <br /> 6. J � 3 0 m <br /> 7. <br /> 'a CD e <br /> wo <br /> o �i';2 M <br /> = c� : m <br /> declare that this application (including any accompanying schedule) has been examined by me and to the best of my 2 C) <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of -,a <br /> Fall information contained in this application (including an accompanyingschedule and I further declare that I recognize m o m <br /> PP ( 9 Y ) 9 !� 0 <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 application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. D o <br /> CDSIGN HERE �i1.� C • <br /> 1 <br /> (signature of owner or hfuifd g ontractor) (date) <br /> ZONING ADMINISTRAT IR f <br /> 1` cfl`cn <br /> tD - ��'�J 7 TOWNSHIP PERMITS MAYBE REQUIRED C" a <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />