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Burnett County 7410 Co. Rd. K, No.102, Siren,WI 54872 Office of Zoning Administrator m c o <br /> APPLICATION FOR LAND USE PERMITS . <br /> ^' r <br /> N O <br /> OWNER TELEPHONE �S —02'//J <br /> m <br /> MAILING ADDRESS ��� /Q <br /> PROPERTY ADDRESS O JI /V Gj I^OAC-/ ]� <br /> of <br /> d <br /> LEGAL DESCRIPTION(see tax receipt) �4 <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ p> <br /> TYPE OF PERMIT(S): o <br /> FILLING/G <br /> R <br /> ADING ❑ CAMPING UNIT 0 SULB91VISION <br /> CL <br /> STRUCTURE/ADDITIONUSE: Ek�si�N; <br /> (Home/Cabin; Commercial Busines , Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: � CSL <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. TO m� <br /> ]7 H <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> T <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. A m 1 �3 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m a `}J <br /> NORTH(N). W o <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 Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 9 <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO �y <br /> BUILDINGS,ROADS, LAKE, LOT LINES. ) i <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. m f <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. �' I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o ` <br /> CONDITIONS OF PERMIT: Di <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. gU) <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. <br /> M 00 <br /> CL M <br /> 6. m 3aMxa I <br /> - W C y O 9 <br /> 7. Z <br /> 9 T m <br /> 1 declare that this application (including an accompanyingschedule has been examined b me and to the best of m _r^ <br /> PP (� 9 Y ) Y Y C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m 0 <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize iP$ E M <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- `• J E <br /> sue a permit. I further accept all liab'. which may be a result of the County of Burnett relying on thiq information I am `• a '� <br /> providing in this application. I ree toperm co ty offici s c rge o i ces or other o <br /> m : =r <br /> authorized persCn <br /> on to have a ess <br /> to <br /> above d cribed p sat a o e f inspection. c <br /> SIGN HERE �3 0 <br /> (sign Ore of owner or d contractor) AUG 2 5 <br /> ZONING ADMINISTRATOR I Linn _ <br /> BURNETT C U <br /> a3y.5� <br /> TOWNSHIP PERMITS MAY BE REQUIRE?PNING U7 <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />