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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v0 z <br /> APPLICATION FOR LAND USE PERMITS 3 CN1 <br /> _ r <br /> N O <br /> d <br /> TELEPHONE 0 <br /> 1J } C S -F-� pal S 5y00 I <br /> MAILINGADDRESS 2�13� o#� l b F <br /> N <br /> PROPERTY ADDRESS `Z$ (0 5�L��errr�`` <br /> LEGAL DESCRIPTION(see tax receipt) Q <br /> m�� a © rI <br /> TYPE OF PERMIT(S): DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE El ADDITION <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ l <br /> STRUCTURE/ADDITIONUSE: f- l M n Se 0 <br /> (Home/Cabin; Corbmercial Business;Bedroo Deck;etc.) m <br /> BUILDING CONTRACTOR: <br /> M <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 6'/a X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m r� G <br /> n n z A <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <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 1 B <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 <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, CONTRACThAr. PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. = O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE ONE Ff , a o <br /> NEEDED. �V1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. vQe <br /> CONDITIONS OF PERMIT: V �j <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 /> 6 SETBACK REA. ��/ � � <br /> it /<.i <br /> 6. Nd � � O l� m onir0MaOM <br /> w <br /> 3 nm Fay <br /> 'O N C ,Nj, y 0 <br /> 7. Z N O <br /> O -n� it <br /> declare that this application (including any accompanying schedule) has been examined by me and to the best of my ID <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m n fA <br /> all information contained in this application(including any accompanying schedule)and I 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 v <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. ° Cl) <br /> o : <br /> SIGN HERE 1 <br /> (sig atur owner or buiLding contractor) <br /> (date) n <br /> d <br /> ZONING ADMINISTRATOR C <br /> . cn En <br /> IfA fA EA fA � N <br /> (T O U(T O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />