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Burnett County 7410 Co.Rd. K,No.102,Siren,WI 54872 Office of Zoning Administrator G) Z <br /> APPLICATION FOR LAND USE PERMITS <br /> ^' r <br /> y O <br /> m /L <br /> C t/Jl <br /> OWNER �b/>h + .1aI1I Ct ��fk/vJ c TELEPHONE <br /> MAILING ADDRESS Rd il/s Lc-/„Z <br /> 1M m� <br /> PROPERTY ADDRESS WeJC11 /ed I `'+ <br /> LEGAL DESCRIPTION(see tax receipt)/V6 6 S J3- <br /> Q —'/Z 1 co <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE kA ADDITION ❑ Q y 0 <br /> TYPE OF PERMIT(S): c� <br /> FILLING/GRADING CAMPING UNIT ❑ SUBDIVISION o; <br /> r <br /> STRUCTURE/ADDITIONUSE: Y&Wt- / C/SFB?�/ 0 UI <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) y <br /> -� > A <br /> m <br /> BUILDING CONTRACTOR: Ji�N vii/ y1 C-/ o0 <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m0 <br /> c <br /> DIRECTIONS FOR PLOT PLAN DRAWING, (AERIAL OR TOP VIEW) p n <br /> T <br /> v z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m CD 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). C O <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. o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO -L <br /> BUILDINGS,ROADS, LAKE,LOT LINES. S t <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. „I <br /> IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. £ t <br /> m <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN tl1 g <br /> NEEDED. <br /> w <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. pp �� <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY N <br /> PERMITTED. p <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE �REQUIRED WATERSETBACK WAIL) C7 <br /> 9 0110vnvM <br /> pCD <br /> 7. " '` S Z u o y o <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> 0 <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of R o in C <br /> ^ i : rn <br /> all information contained in this application(Including any accompanying schedule)and I further declare that 1 recognize •� CRL 0 c o me <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. 1 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 v ' <br /> authorized persop4o have access tq the abovescribed premises at any reasonable time for the purpose of inspection. n ce <br /> CD o <br /> SIGN ERE ' e4) Ite.)� m <br /> En <br /> (sl nature owner or building contract ) (data) a' <br /> ZONING ADMINISTRATOR- <br /> fy u �C 4CIS <br /> TOWNSHIP PERMITS MAY BE REQUIRED d `' <br /> PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />