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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o <br /> APPLICATION FOR LAND USE PERMITS 0 <br /> 3. <br /> r,. r <br /> a, o <br /> c <br /> CD <br /> OWNER TELEPHONE ��— 3 0 <br /> D o <br /> �- O <br /> MAILING ADDRESS <br /> r � <br /> o <br /> PROPERTY ADDRESS AA rQ <br /> J <br /> r ." <br /> LEGAL DESCRIPTION(see tax receipt) QCD <br /> d <br /> n <br /> DWELLING/BUILDING F-1 GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ (n 0 <br /> 0 <br /> TYPE OF PERMIT(S): C =3 <br /> Cr <br /> FILLING/GRADING CAMPING UNIT El SUBDIVISION ❑ Q. <br /> StRUNIUK-711 ORErAMIN USE: n tivG T Afy T -rwe. �i2 �y 0'J <br /> o' <br /> H e/Cabin; Commercial Business; Bedroom; Deck; etc.) cn <br /> v <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. "n <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O cv W <br /> -n a <br /> " Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C� <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m CD �- <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 ©°I 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. 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 0 O� <br /> MUST BE SIGNED AND DATED BY THE OWNER. o 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: o (� <br /> V r <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. Q <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. �C& v 65: 4011-CQO /r T- DOWPJ S'LO/ i)1t4)AJI<T vw/S�L'T F / ZRT r <br /> tiJ X Oo C� D O D 0 1 <br /> 6. �e S�G-�oa& •k NLULG�-4CSp (,r*N Gam/?L C l Off- ��//V G, 0 � a a <br /> ornC � cn � � = <br /> c (nCn0 :3 <br /> 7. o -n <br /> — (n . r <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my = � <br /> C:knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of a c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize CD I <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 permit. I further accept all liabilitywhich may be a result of the Count of Burnett relying on this information I am ®� o <br /> y y y 9 <br /> CD <br /> providing in this applicati I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to ccess to the above d ibed premises at any reasonable time for the purpose of inspection. `D a <br /> m <br /> rm D <br /> ---------- - -- n 1 z0 /0- 1 tD - . <br />