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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v O z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> W1MER4 �l p 110.4, d l — [1715 <br /> }} TELEPHONE <br /> 7q3 Pr ���JJJ---� <br /> MAILING ADDRESS �� �— UU� ���l r y O� <br /> 9/0 -4-1 <br /> M <br /> 0 m <br /> 0 <br /> PROPERTYADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) s� <br /> t / I <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION O y 0TYPE OF PERMIT(S): <br /> a <br /> FILLING/G NG CAMPING UNIT ❑ SUBDIVISION ❑ �. <br /> /9-di�7`tn2 fa �I <br /> STRUCTURE/ADDITIONOSE: 3 oN <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Cl) <br /> BUILDING CONTRACTOR: <br /> S17 �- <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> O y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p C <br /> -n a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. Tz <br /> 0 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE 0 9i <br /> m 9 <br /> ri <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 d <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. I (n 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. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS 0 aN <br /> MUST BE SIGNED AND DATED BY THE OWNER. S 1 <br /> f <br /> o 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN0 g <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z <br /> CONDITIONS OF PERMIT: P A <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. iW. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY F <br /> PERMITTED. r , <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER w <br /> SETBACK AREA. <br /> 5. /n Y� <br /> 6. �l�Qom'— Il. m eni r o 0 n 'D <br /> 3 3 0 mn m <br /> O NC <br /> 7. Z N N O O t0 <br /> O TSG it <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 6 N : A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of o n : v, : C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognizem o m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining who to is- : M <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 d <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 premises at any reasonable time for the purpose of inspection. m : C <br /> SIGN HERE G� " —�V /O' �" m <br /> (sl ature of owner or ding contractor) (date) ` n <br /> ZONING ADMINISTRATOR <br /> 69 fA fA EA � N <br /> N V tN N O O <br /> U <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 Mtn OO <br />