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Burnett County 7410 Co.Rd. K, No.102,Siren,WI 54872 Office of Zoning Administrator v G) Z <br /> APPLICATION FOR LAND USE PERMITS CD ° <br /> r <br /> ` y O <br /> OWNER ' TELEPHONE n <br /> MAILING ADDRESS111�� : C 'e <br /> ^ 1 r m <br /> PROPERTY ADDRESS ' `a d C `u1 RA ^z °» <br /> ^ �y y <br /> LEGAL DESCRIPTION(see tax receipt) C <br /> og <br /> ' qj `� �$ Lo- -z C S INA• I(e n Z Z� Q w <br /> 1— <br /> DWELLINGBUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ElTYPE OF PERMIT(S): cn o <br /> FILLING/GRADING ElCAMPING UNIT N SUBDIVISION ❑ a <br /> STRUCTURE/ADDITIONUSE: r Gt YVID 1^!Ol LILV\l+ fpr MOIL HnS <br /> 0 <br /> (Home/Cabin;Commercial Business; Bedroom; Deck; etc.) m Jo' <br /> BUILDING CONTRACTOR: <br /> t <br /> z 3 <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m3 <br /> 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 m J <br /> Oo.m <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T o z a <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> m g C� <br /> NORTH(N). (�p <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 <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. c <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. ( O <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 1 W <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS N <br /> MUST BE SIGNED AND DATED BY THE OWNER. � i <br /> o t <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. ° <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: o 1 <br /> i Q <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. 1 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 6. <br /> X e0i r.- 0n m A C -0 <br /> 3 o. m A x�a F m <br /> m <br /> 7. m Cy `� o <br /> Z N C O 7 G <br /> O T t <br /> I declare that this application (including any accompanying schedule)has been examined by me and to the best of m ` ` : D <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of J: w o in:' C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize ,� m o remit <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Is-ze ' siIn <br /> sue a permit. I further accept all liability which may be a result of the County tt Burnett relying to this information I am i m <br /> providing in this application. I agree to permit county oNicials charged with admin t <br /> authorized per n to have access to the above described premises at any reasonabl t e m cn 6 <br /> -n of <br /> SIGN HERE i <br /> ( n ure of owner or!wilding contractor) ��� � (�t�5 a. <br /> ZONING ADMINISTRATOR <br /> BURNETT COUNTY Q>N(�/ N ro O <br /> TOWNSHIP PERMITS MAY BE REQUIRED ZONING o ch O u, o, o 0 <br /> THIS ERMIT HALL EXPIRE ONE Y ARF OM E OF I UAN E <br />