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Burnett County 7410 Co.Rd. K,No.102,Siren,WI 54872 Office of Zoning Administrator -0 o° c <br /> CD <br /> APPLICATION FOR LAND USE PERMITS <br /> m O <br /> (/1 <br /> O <br /> V O <br /> WNER TELEPHONE < SQ m K <br /> � / <br /> MAILING ADDRESS <br /> r <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) L y ��_ 3 s-4 ' (1O pcn <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE T�t ADDITION ❑ fn <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING UNIT ElSUBDIyISION ❑ < <br /> La <br /> -� f <br /> STRUCTURE/ADDITION USE: 6 > U /Cy 0 <br /> �p, t (Home/Cabin; Commercial Busine s; Bedroom; Deck;,e c.) <br /> '�" "1 l�J I�� C a <br /> BUILDING CONTRACTOR:// p l��ll i,(x� d J D(Yl �(l A f '�7�3'� � Q <br /> 7� 7 Irl ' <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 1 t SHEET OF PAPER. ANY INCOMPLETE OR m � <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> 3I C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> T o z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m jp <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE a 0 <br /> NORTH(N). to 3 <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. <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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. ly <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS I <br /> MUST BE SIGNED AND DATED BY THE OWNER. n <br /> O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN SLI <br /> NEEDED. <br /> I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c _ <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <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 ` <br /> PERMITTED. I <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 6. m S a m a <br /> a m <br /> ca N 0 7 <br /> 7. Z w m O <br /> C T z ' M <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m —�b ` 0 <br /> PP (' 9 Y ) Y Y G0 2 ; C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of d <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 Burnaft-Wisconpin in determining whether to is- <br /> sue a permit. I further accept all liability which may be a result of the CmMtyl Of Surtis�f deW19 information I amproviding in this application. I agree to permit county officials charge ,with�infige i�n��Vrp� antes or otherauthorized person to have access to the above described premises at y reasonabTe trfdrthd of inspection. m m E o <br /> (D <br /> iftn <br /> SIGN HERE �� 2 ` CL : <br /> Z: <br /> lure of wner or building contractor) ate) <br /> r 3URNE7T _ lN . Z. <br /> �rn �ilc1 COUNTY _`� N <br /> ZONING ADMINISTRATOR � � <br /> zoNirvo a6' ,4- r-3 400 <br /> � o <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />