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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 /> r$ <br /> c <br /> OWNER ''' / f., � `-�rsoJ'l TELEPHONE <br /> C _O <br /> 91 <br /> O <br /> MAILING ADDRESSCD <br /> CD <br /> r <br /> 0 <br /> PROPERTY ADDRESS <br /> � O <br /> LEGAL DESCRIPTION(see tax receipt) <br /> m <br /> _ V1 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ I Cn o <br /> TYPE OF PERMIT(S): }� a = 1 <br /> FILLING/GRADING�QCAMPING UNIT /S SSUUBDIVISIIOO/N�❑c < C <br /> STRUCTURE/ADDITION USE: <br /> (�I oome/Cabin; Commercial Business; Bedroom; Deck; etc.) cn <br /> BUILDING CONTRACTOR: v' <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p - 7` <br /> m <br /> Ip <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m o T Q <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). w <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 Z <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 C <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 I D ^� <br /> MUST BE SIGNED AND DATED BY THE OWNER. �J-)2 o <br /> Gov � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. (,t <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o A I 1 <br /> CONDITIONS OF PERMIT: o` <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Q <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. <br /> X co O r D O D O _0 <br /> 6. m ,c3am OxR ;a <br /> o m C N �' F <br /> Z c ti m o <br /> 7. <br /> _ C, : m <br /> 1 declare that this application (including an accompanyingschedule has been examined b me and to the best of m = D <br /> PP (� 9 Y ) Y Y C <br /> J . <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of w' �CL _ <br /> all information contained in this application (including any accompanying schedule)and 1 further declare that I recognize _ mm <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- U <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information 1 am <br /> providing in this application. 1 agree to permit county officials charged with administering county ordinances or other j <br /> authorized person to h access to the above described premises at any reasonable time for the purpose of inspection. m a <br /> D1� � a <br /> SIGN HERE a <br /> (Signature <br /> yof wner or building contractor) (date) o <br /> ZONING ADMINISTRATOR �i' f I FUn- `+ ' <br /> � b9 fiY Hi�N <br /> O N (ll W W N O <br /> TOWNSHIP PERMITS MAY BE REQUIRED d <br /> THIS PERMIT SHA S A <br /> L XPIRE ONE YEAR FROM D TE OF ISNCE <br /> `Rrait - + Ie f-k(- -P/c tea k19 �y7orn lsfo�he�Son Maras' <br />