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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. = <br /> .4oV t FT AL _ r <br /> OWNER l_ _1' F ,%V� TELEPHONE <br /> /� , 7� I �// <br /> MAILINGADDRESS 3li V &Q-cyno n Di �''�(1 Js V lrm f1i O <br /> CDCD <br /> PROPERTY ADDRESS <br /> t .1/ <br /> LEGAL DESCRIPTION(see tax receipt) t 3 � -/Y �13c1 ti l.(./ t M T <br /> Q <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ Q) T <br /> TYPE OF PERMIT(S): n <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ S. <br /> ^^J�� 1 t n—W r`0. W� A{h` <br /> T. 0 <br /> STRUCTURE/ADDITION USE: d �c q6 0 <br /> (Home/Cabin; Mmmercial Business, Bedroom; Deck; etc.) to <br /> BUILDING CONTRACTORCD <br /> C <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 - <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 o <br /> in <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). (Cis O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m <br /> CENTERLINE OF ROAD,(C) BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF n Z <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. VJ ° <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. i Q' <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. J 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. 0 <br /> O :3 W <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN 0 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: o Q <br /> G'1 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. J O <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. 1j) <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. _ p <br /> 5. �'f)'(cL1'tXe /U JI �D �Q �be(1^ 4;1 <br /> C W o> 0 > * M <br /> 6. m ,'c3am � �" � � <br /> (D (Z o 3 <br /> 7. <br /> P m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m - r^ 0 <br /> PP ( 9 Y ) Y Y G) C <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of <br /> all information contained in this application (including any accompanying schedule)and I further declare that I recognize m C m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- CD U) t7 <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 : o <br /> CD <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <br /> authorized person to have access to the above des c ibed premises at any reasonable time for the purpose of inspection. ° a <br /> m <br /> D <br /> SIGN HER - <br /> sig Lure of ow ilding contractor) (date) o <br /> ZONING ADMINISTRATOR <br /> to sv t» <br /> e it <br /> TOWNSHIP PERMITS MAY BE REQUIRED Oo cl cn o <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />