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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 O Z <br /> APPLICATION FOR LAND USE PERMITS ° ° _ <br /> ^ r <br /> m0 <br /> y <br /> C <br /> OWNER TELEPHONE <br /> t�JJ 0 <br /> d <br /> MAILINGADDRESS m O <br /> F <br /> CD <br /> r nr <br /> PROPERTYADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) � O <br /> CD <br /> TYPE OF PERMIT(S): <br /> DWELLING/BUILDING �, GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> STRUCTURE/ADDITION USE: o <br /> b,0 <br /> h (Home/Cabin; Commercial Business; Bedroom Deck; etc.) O <br /> BUILDING CONTRACTOR: br <br /> /1 U e b f o wn 1 r Ca y9_e LOS <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR CD <br /> 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. OT <br /> DIRECTIONS FOR PLOT PLAN DRAWING' (AERIAL OR TOP VIEW) O m <br /> n a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> m m <br /> NORTH(N). C <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO m X33 <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF t <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. �Q 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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. If N c7>6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS O 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. 0 -- <br /> tO f 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> n o <br /> NEEDED. 3 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> Vl � <br /> CONDITIONS OF PERMIT: P N <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT b <br /> ISSUANCE. -�D t v <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Cly 0) <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY _fes r <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER Q Q <br /> SETBACK AREA. <br /> 5. <br /> �] OOOr DODO -0 <br /> 6. m m d 0 0 n � m <br /> m 3 n m 0- o' <br /> omC: o 3 <br /> 7. Z C y 0 ' ca l <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best21,of my G) A <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of 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 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m in <br /> sue a permit. 1 further accept all liability which may be a result of the County of Burnett relying on this information I am G o <br /> providing in this application. I agree to permit county officials charged with administering count ordinance pLother <br /> authorized p on It have a e s to the above described premises at any reason f on. m <br /> -n a ; <br /> SIGN HERE ° n <br /> (sig�e of owner ilding contractor) date <br /> ZONING ADMINISTRATOR OCT 2 5 2004 <br /> Gi <br /> TOWNSHIP PERMITS MAY BE REQUIROURNETTCOUNTY O <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSVQNNNG <br />