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Burnett County 7410 Co.Rd. K,No. 102,Siren,W154872 Office of Zoning Administrator -U 0 0 <br /> APPLICATION FOR LAND USE PERMITS �. <br /> N <br /> N <br /> 4'/��, / <br /> OWNER _ TELEPHONE U `�' C� - q <br /> C <br /> MAILING ADDRESS ��j (� U SQL✓ L v e <br /> ho <br /> PROPERTY ADDRESS /ilk/s 5 �'3y ) <br /> LEGAL DESCRIPTION(see tax receipt) L Cs rn 'I l k ioa ( <br /> DWELLING/BUILDING ElGARAGE/ACCESSORY STRUCTURE ❑ ADDITION ® Cn 0 <br /> TYPE OF PERMIT(S): 41c <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ o; <br /> STRUCTURE/ADDITION USE: �/�I IV �� ( 0 rp <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) <br /> 2.SD 1 <br /> BUILDING CONTRACTOR: C�iCbi � p <br /> Z � <br /> U <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81k X 11 SHEET OF PAPER. ANY INCOMPLETE OR m 3 C <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. ._. <br /> � N bb Q <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> m <br /> M Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m D <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). W TZ 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 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. <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. Q <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. f <br /> O <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 O <br /> CONDITIONS OF PERMIT: O I <br /> t \. <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT .(1 <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY Q <br /> PERMITTED. UJ <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5 1 .�3� 9 nr DODOM <br /> CD m m 0 m a f m <br /> 6. m 3 am m <br /> - N C y N O <br /> 7. Z y O 0 <br /> P TC m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m O <br /> PP (� 9 Y ) Y Y L7 <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m c0i ; C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 1 J: <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 <br /> providing in this application. 1 agree to permit county officials charged with administering county ordinances or other ra: o <br /> authorized person to IMve access to the aba described premises at any reasonable time for the purpose of inspection. m 0 <br /> uTt o <br /> SIGN HERE ` ( m <br /> (sign a of own r building ntractor) (date) a <br /> W <br /> ZONING ADMINISTRATOR Qji <br /> ,S <br /> TOWNSHIP PERMITS MAY BE REQUIRED v \04- <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />