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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator -0 Z <br /> APPLICATION FOR LAND USE PERMITS 3. o <br /> r <br /> vi O <br /> OWNER LEPHONE � <br /> CD <br /> MAILINGADDRESS / �10Z 0 �7 O <br /> PROPERTY ADDRESS I <br /> LEGAL DESCRIPTION(see tax receipt) �) <br /> t T m <br /> TYPE OF PERMIT(S): DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ c�0 <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> <�l <br /> STRUCTURElADDITIONUSE: Gavagti o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) (n <br /> m <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> CD <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n 3 N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) M <br /> O a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T� Z <br /> O A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE 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 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. Z <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO Q>BUILDINGS, ROADS, LAKE, LOT LINES. W <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N (1 t <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. F <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN 0 <br /> NEEDED. . <br /> I1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z C:>. <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. L070s Q �cNNof be s�/d sQP ted GtiYeSS S'�;*VC;0u n,0eed fia N►ee�- <br /> 6. Std dot Llwes, m WW00. M <br /> iu0 <br /> m a f m <br /> 0 > > n n <br /> m. =c3 am �c � � ic <br /> -__..--.- O O N C y y <br /> Oic <br /> 7. Z C N N O : O <br /> O (D TI <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my — i, A <br /> E G7 <br /> knowledge and belief it is true, correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of pn: <br /> d : <br /> all information contained in this application (including any accompanying schedule)and I further declare that I recognize C : m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- .sue a permit. I further accept all liability which may be a result of the County of B ior?I am ' o <br /> providing in this application. I agree to permit county officials charged with a i m nt ��a �3^ i ther m' <br /> authorized person to have access to the above de ribed pre ises any reas i r t� rp e dtdhls �t on. � <br /> -Ti n : <br /> n _ m <br /> SIGN HERE - `r — j E Q <br /> (si t of owner bui di contractor) S o <br /> ZONING ADMINISTRATORTT- GOUNTY <br /> lop, 9URNE <br /> En: is e» <br /> 0 EA lfl fA EA N <br /> ZONING <br /> O N 1 I W W N O <br /> TOWNSHIP PERMITS MAY BE REQUIRED O <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />