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Burnett County 7410 Co.Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator -0 ci Z <br /> CD <br /> APPLICATION FOR LAND USE PERMITS ° ° <br /> r <br /> y w <br /> C <br /> OWNER /'RN1 �/�t/70r�I /r r�✓J Yl't TELEPHONE "`7/� �SfCJ 4 / '7�� 'ft cb i• <br /> MAILING ADDRESS 8 S 14/ e� 5�J <br /> 'l m <br /> PROPERTY ADDRESOPI'e C'0 Alh <br /> VAIN 1 ��y �, , 511-p3ci o_ <br /> lo_ 3c)-v3 1 E E ex. s ao v" <br /> LEGAL DESCRIPTION(see tax receipt) z 9CD <br /> �7� <br /> DWELLING/BUILDING ® GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ G o <br /> TYPE OFPERMIT(S): Ulcn <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> Di'YJ,E y <br /> STRUCTURE/ADDITION USE: o <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) W r <br /> BUILDING CONTRACTOR: &4QjbMJ <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. _n <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p CD <br /> n a <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> m 70 <br /> NORTH(N). C n <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. o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO 0 <br /> BUILDINGS,ROADS, LAKE, LOT LINES. N g <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS N( 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o F <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN � o <br /> CQ <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z <br /> CONDITIONS OF PERMIT: o <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. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 6. m m m 0( a f m <br /> CD <br /> 7. Z N O N fo <br /> P -n� : >] <br /> declare that this application (including any accompanying schedule)has been examined by me and to the best of my cj E O <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of 1 w n v, C <br /> PP (including Yaccompanying ) g 10C ` u <br /> all information contained in this application mcludin an schedule and I further declare that I recognize m � : 0 : m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin iIng; <br /> mining whether to is- M <br /> sue a permit. I further accept all liability which may be a result of the Coy �f:jff' a his information I am m <br /> providing in this plication. I agree to permit county officials charpe� wr dpti xi t r Ordinances or other E <br /> authorized p so o hav a ss to the ove described premises atl alliy}e�na d%q oge of inspection. : 'c 0): <br /> m ° o E <br /> nm m <br /> SIGN HERE �i ' D3 to i m i <br /> (signature r or building cot tor) (date) ` o_ <br /> ZONING AD NISTRATOR TY C <br /> ZONINGCA�A69fA <br /> � <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> Y �1p <br /> 03 IS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />