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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> N <br /> C <br /> OWNER7/J r4J� <br /> lo em <br /> TELEPHONE r O <br /> m <br /> c <br /> MAILING ADDRESS <br /> PROPERTYADDRESS <br /> 9j <br /> nI , ^ <br /> f e <br /> LEGAL DESCRIPTION(see tax receipt) 3 / � ,! (0/7cn <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ / ("\ to 0 <br /> TYPE OF PERMIT(S): <br /> FILLI;;ADING ❑ CAMPING UNIT ❑ SUe ION <br /> STRUCTURE/ADDITION USE: / / / UI v I <br /> (Home/Cabin; mme ial Bu s; Bedroom; Deck; etc.) to <br /> v _ <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> M w <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) OT (D <br /> MZ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m o A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATECD <br /> NORTH(N). ( ` <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. 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 Sb <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. n t <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> -t <br /> NEEDED. d <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o Q <br /> CONDITIONS OF PERMIT: <br /> c <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. W <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <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 /> CD Wmm0Mcl � m <br /> 6. m x 9 n 0.0 Cl ;a <br /> O N C y y 0 CD <br /> C 3 <br /> 7. Z C N ry O <br /> N -nC M <br /> — C. [ m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of mA <br /> pP (� 9 Y ) Y Y G`>2,— � C <br /> knowledge and belief it is true, correct and complete. I acknowledge that 1 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 c m <br /> CD <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 pe jhi <br /> ther acce all liability which may b esult of the County of Burnett relying on this information I am m o <br /> providin in tpplication. gree to perm�t c o icials charged with adm'author' ed peto h ve c to the above d s ed remises at any r asonab i o he o s i m n <br /> T <br /> CD D <br /> m n . <br /> SIGN E " a <br /> ' 9 ' JUN 2 <br /> "t" <br /> L X1005 <br /> si at e o ow o w �n contractor t <br /> ZONING ADMINISTRATOR <br /> in E»oa <br /> BURNETT COUNTY <br /> O N O CWI� (li UO <br /> TOWNSHIP PERMITS MAY BE REQUIRED ZONING <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />