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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 /> rn O <br /> y iy <br /> pI a <br /> OWNERj TELEPHONE 0 C <br /> m (� O <br /> MAILING ADDRESS a o a Cedar 20a; G0. r " <br /> f 0 <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) S 'la s �E 3 —� l 8 9 <br /> DWELLING/BUILDING ® GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ 0 <br /> L <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT 1:1 SUBDIVISION ❑ m, w` <br /> STRUCTURE/ADDITION USE: l <br /> (Home/Cabin;Commercial Business;Bedroom; Deck; etc.) (n <br /> w <br /> BUILDING CONTRACTOR: 2 <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m � <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 w <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> -n O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m D <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB) ND INDICATE C <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDIN (S)TO m <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(O AWM)OFQb W o <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 DISTA CES 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,CONT, TOR,ET .,THE PLANS 02. <br /> MUST BE SIGNED AND DATED BY THE OWNER. ° c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIF TIO ONe 1 �• <br /> NEEDED. <br /> 4PR Z ' <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 2 ° <br /> CONDITInNS OF PERMIT: <br /> f <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMITISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. NDN N' r <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. 9 0)Or- > V > 0 <br /> CD m 9 <br /> -J cmi a f 1r1 <br /> S a m x m <br /> m • 3 <br /> 6. a m y y y J c q <br /> Z y O ; <br /> 7. O �112 i m <br /> �CD i IS <br /> 1 declare that this application (including any accompanying schedule)has been examined by me and t the best of my <br /> I <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of J o.E N <br /> m o : m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize _ � i7 <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determine g whether to is- m <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this nformation I am <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other ; o ° <br /> m E � <br /> authorized person to have access to the above described premises at any reasonable time for the purpo9e of inspection. -no : <br /> iu <br /> SIGN HERE Ck; (date) o ` <br /> (signatu f owner or building contractor) ( O <br /> \rn i E i i i <br /> ZONING ADMINISTRATOR <br /> �o� � oo <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> uf'- aSsa t. <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />