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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator c) Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r 4 <br /> UT o 1v <br /> N ^ ' <br /> _ C V <br /> OWNER ' C G r� / TELEPHONE () n <br /> v n O <br /> MAILING ADDRESS a ��/[) pr(�� / /C F ry, J r✓ J y S ` O <br /> PROPERTY ADDRESS S C o <br /> LEGAL DESCRIPTION(see tax receipt) � ya /f <br /> rn <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION <br /> TYPE OF PERMIT(S): (�' � <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION 1 a <br /> j <br /> STRUCTURE/ADDITION USE:S /} -T & a A x 3� <br /> 0 g <br /> o' <br /> (Home/Cabin,COMMePtial Business; Bedroom; Deck;etc.) ' <br /> -� ` /' <br /> BUILDING CONTRACTOR: =(q A C /� � �L/c <br /> m <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 3 <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) <br /> O m <br /> T a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALLNEW BUILDINGS(NB)AND INDICATE m v <br /> NORTH(N). <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 v <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. Z <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO o <br /> BUILDINGS, ROADS, LAKE, LOT LINES. C) <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED.6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE PLANS 0 <br /> N <br /> MUST BE SIGNED AND DATED BY THE OWNER. � oCIO <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: Zo O <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYSOF 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 111 ,,,111777111 <br /> PERMITTED. <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5.�� <br /> 7. 'O ((DD C N N p j 3 <br /> Z N (D <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my o m� A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of d(`, ;, m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize �' Co ' m <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 liability which may be a result of the County of Burnett relying on this information I am v <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have acre to the above described premises at any reasonable time for the purpose of inspection. <br /> . : in <br /> m <br /> o . <br /> SIGN HERE f CD <br /> p <br /> (signature o ner or building cont t ) ' <br /> (date) <br /> ZONING NISTRATOR <br /> fR fH fA EA 0+N <br /> CSN CnNN 00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED rV: o v o 0 0 <br />