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Burnett County 7410 Co.Rd. K,No.102,Siren,WI 54872 Office of Zoning Administrator -0 0Z <br /> APPLICATION FOR LAND USE PERMITS g o <br /> N <br /> C �J n {� r n V <br /> OWNERa V✓�i< lg TELEPHONE ! 3- 3 1 !� ( r J O O 3 Vi <br /> �p <br /> p �M m / <br /> MAILINGADDRESS Soo Slthrn4 (�4:A Lh. acal" 06AIr,. VgK .sS-1/ <br /> ry <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) <br /> DWELLING/BUILDING ❑ GI ARAGEIACCESSORY STRUCTURE ADDITION ❑ rn = jo <br /> TYPE OF PERMIT(S): -4�- c <br /> FILLING/GRADING 1:1CAMPING UNIT ❑ SUBDIVISION ❑ o; <br /> STRUCTURE/ADDITIONUSE: dV r-, o2 2 yC 2U 0 <br /> P <br /> R(Home/Cabin;Commercial Business; Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: 1 !Ae 1CD <br /> rJLl c tr N' h C� <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 9 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p " U� <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T a <br /> � z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m j0 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m O <br /> NORTH(N). fn 0 <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 <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. c <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. `< O <br /> S. 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 00 <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> O O W <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN (� <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> 0 <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT W <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 O <br /> PERMITTED. C <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS.ETC.. ALLOWED WITHIN THE RFOUIRED WATER <br /> SETBACK AREA. This structure to be used as private residential <br /> 5. garage/storage only. Not to be used for human <br /> M OrDaDOV <br /> 6 habitation. 0 S a m n <br /> o N C <br /> 7. o m� <br /> I declare that this application (including an accompanyingscneouie nas peen exammeo o me ano to me best of m T <br /> PP (' 9 Y 1 Y Y -, 2 C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of w o v,: <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize : m o <br /> rn <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 m E <br /> providing in this applie I agr to permit county officials charged with ad m r er o <br /> authorized person t h acts the above described premises at any reaso i o u �+ f i n. m o <br /> SIGN HERECL <br /> (signa�f owner or building contractor) (r1aWs . . . <br /> ZONING ADMINISTRATOR I M ItrilG�1r� OCTUla 1 C CUU4 <br /> fAHfA GN�N <br /> BURNETT COUNTY <br /> / C N 0 N N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED ZONING 0 in o at cn 6 <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE �� <br />