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Burnett County 7410 Co.Rd. K,No.102,Siren,WI 54872 Office of Zoning Administrator v ci Z <br /> APPLICATION FOR LAND USE PERMITS . <br /> r <br /> y O <br /> tp <br /> C <br /> OWNERA/iRy A�� TELEPHONE 7/5 a yb -505-? <br /> 0 <br /> w <br /> .li m <br /> MAILING ADDRESS 109-) i3oT �V � ✓ �Tc�l/>>c�.un t,�s sya)7 <br /> PROPERTY ADDRESS CTy R(J H (A eb �) <br /> LEGAL DESCRIPTION(see tax receipt) /739 R►y +.v AC-c-� ad I <br /> a-3q -iy -09 -o 63)00 5F_ 5t <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ ti � <br /> TYPE OF PERMIT(S): _ _ _ __ <br /> FILLING/GRADIING ❑ CAMPING UNIT ❑ SUBDIVISION LJ 5 <br /> STRUCTURE/ADDITION USE: C A I&IAJ c <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: SELf <br /> m <br /> 0 <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. TO <br /> 3I H <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> m <br /> ?I o z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m � X2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). <br /> n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m b <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 O o 1 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> v � <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 <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <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 /> SETBACK AREA. <br /> 5. <br /> 6. 9 m w 00 A c v v <br /> CD 3 am nm <br /> .� mC0 ' O = T+ <br /> N m o 0 <br /> 7. p� 'Q <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m —m' O <br /> PP (� 9 Y ) Y Y <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of W: CW <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize I/�� m C $ m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Is- m v <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 '1 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other ; <br /> authorized person to havp access Mthe above described premises at any reasonable time for the purpose of Inspection. a, U <br /> n �J m o <br /> SIGN HERE 0 <br /> (signature of owner or building contractor) (date) o; <br /> ZONING ADMIN ISTRA'VR <br /> : <br /> N O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />