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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v Q Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> VT 0 <br /> OWNER %CJ U / �� V(� e- TELEPHONE 7/-57-3 Z 7," l�S n <br /> o <br /> n // cLO d <br /> MAILING ADDRESS Z t7�j,s �r�.Cc //�C 0 4*1 !/ {"' /L/ea1e,,j C Lu 1-5-4193 10.3 OF <br /> PROPERTYADDRESS S jy4 e <br /> LEGAL DESCRIPTION(see tax receipt) 0 3 L f 6 Q/ !f Q r) C <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ (n 0 <br /> TYPE OF PERMIT(S): <br /> Q <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISI N n <br /> STRUCTURE/ADDITIONUSE: 4 r om e- 0 <br /> (Home/Cabin;Commercial B siness;Bedroom; Decl?'etc.) <br /> 301 <br /> BUILDING CONTRACTOR: F <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> 0 io <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) Om <br /> -n a <br /> n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m :b <br /> 2.. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m M <br /> NORTH(N). <br /> n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <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 <br /> BUILDINGS,ROADS, LAKE, LOT LINES. `e a <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 O <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <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. <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> m <br /> 6. 8 3nm0nm >J <br /> 'O m C <br /> 7. Z w o : 1 <br /> O G ZI <br /> M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of iv in <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize m ; o m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <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 m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m o <br /> m m <br /> SIGN HERE j d' <br /> CL : <br /> (sign of ownor building contractor) (date) <br /> ZONING ADMINISTRATOR ' <br /> fA fA fA fA�N <br /> N (T N N O O <br /> to O N (T O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />