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Burnett County 7410 Co.Rd. K,No.102,Siren,WI 54872 Office of Zoning Administrator - o° o <br /> APPLICATION FOR LAND USE PERMITS <br /> y O <br /> OWNER TELEPHONEjr 3Q n S <br /> (D o <br /> MAILINGADDRESS rCj��7 �h S �Jd �✓ �� <br /> / m <br /> PROPERTY ADDRESS � r <br /> � ��ll�kl d .S' o r G/ S 2O U1 <br /> LEGAL DESCRIPTION(see tax receipt)60 x/ vif�4 �S ��9/Y l� mv n F� u�C d l CD <br /> � <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑� '� m 0 <br /> TYPE OF PERMIT(S): Cr <br /> FILLING/GT,DING ❑ CAMPI G UNIT SUBDIVISION ❑ <br /> STRUCTURE/AC-111-11---- a <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) U <br /> BUILDING CONTRACTOR: <br /> CDv <br /> I <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'h X 11 SHEET OF PAPER. ANY INCOMPLETE OR n <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p W <br /> M N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T n <br /> :3 o z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. jp <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m AS <br /> NORTH(N). y o <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. <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO 7' <br /> BUILDINGS,ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. i N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS 2- (` <br /> MUST BE SIGNED AND DATED BY THE OWNER. 1 <br /> v <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. c ' r <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT- <br /> ISSUANCE. IV -`[&� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHO <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY ccm I/-) C3c) 0 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REC IRED tAT�R <br /> SETBACK AREA. ����4 6 <br /> 5. 6K, 0.C . 5-(c'oq 9URN :00r O > 0 -0 <br /> 6. �oNI1VG COUNTY 3 R-M o- a1 m.o <br /> a m C y y o � C <br /> 7. Z y m o i :q <br /> o n m <br /> 1 declare that this application (including an accompanyingschedule has been examined b me and to the best of m <br /> PP (� 9 Y ) Y Y <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of a 0 64 <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o mCDo <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 6 <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 QO <br /> providing in this application. I agree to permi county offic' Is charged with administering county ordinances or other <br /> authorized person to hjWe access to the abgvb des d emaises at any reasonable time for the pu pose of inspection. - o <br /> SIGN HERE C <br /> (signature of owndr'or building c/Y) ontra tor) (date) n <br /> ZONING ADMINISTRATOR ) I E E <br /> 1 Y�/� "' �Il TOWNSHIP PERMITS MAY BE REQUIRED <br /> V 6'�' THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />