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`1 vviviru I t:WbUANNED <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o° o <br /> APPLICATION FOR LAND USE PERMITSCD <br /> r <br /> C <br /> c <br /> OWNER /41 &f7d TELEPHONE '/lY 0`6(p-516 o v l <br /> m <br /> MAILINGADDRESS 90? 5wtr e bur O <br /> PROPERTY ADDRESS 0 9 0 / / Sv V e Og e <br /> �I <br /> LEGAL DESCRIPTION(see tax receipt) (n <br /> (D <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION U) <br /> TYPE OF PERMIT(S): Q <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITION USE: QP� �i °. <br /> D ` <br /> ( e/Cabin; Commercial Business; Bedroom; Deck; etc.) (n <br /> BUILDING CONTRACTOR: <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> C DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a JlJ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 � <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(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 <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 <br /> BUILDINGS, ROADS, LAKE, LOT LINES. 0 <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. ( N n� <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS )lJ <br /> MUST BE SIGNED AND DATED BY THE OWNER. n f <br /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN .`» 0 <br /> NEEDED. Qj <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z J <br /> CONDITIONS OF PERMIT: o <br /> i <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. Ln <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 /> ^ <br /> 5. Aj Ptf <br /> 1 X co r- D0D0 � <br /> 6. m cn� CD0CDn. � m <br /> m B a m X <br /> o m C � <br /> 7. Z c in o a -f <br /> p C : „� ' m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> �J c � <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of // , w � C <br /> _ <br /> all information contained in this application (including any accompanying schedule)and I further declare that I recognize W m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- `D (n <br /> sue a permit. ►further accept all liability which may be a result of the County of Burnett relying on this information I am v o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premjses at any reasonable f r n. m <br /> T a : <br /> ti D : <br /> SIGN HERE a <br /> (signature of owner or building contractor) (date) o <br /> n Qi <br /> ZONING ADMINISTRATOR l�� 1 rla1� nMAR <br /> n <br /> (A fA N <br /> TOWNSHIP PERMITS MAY BE REQUIRED BURNE17 COUNTY �, <br /> TF S PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF 1`�SISU� N� <br />