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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> rn <br /> 41 <br /> . C <br /> N <br /> OWNER to TELEPHONE <br /> MAILING ADDRESS O <br /> E <br /> PROPERTYADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) c (d <br /> DWELLING/BUILDING ❑ •v ❑ <br /> GARAGE/ACCESSORY STRUCTURE ADDITION Cy o <br /> TYPE OF PERMIT(S): W <br /> FILLING/GRADING ❑ MPING UNIT 1:1 SUBDIVISION ❑ t a <br /> STRUCTURE/ADDITION USE: o w <br /> (Home/ in; Ccy6mercial Business;Bedroom; Deck; tc.) <br /> BUILDING CONTRACTOR: <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. T <br /> 0 y �n <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> n Z <br /> 7. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n �b <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m S- <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 10 <br /> a3 <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. r 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. oa <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. �l ) <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS �! <br /> MUST BE SIGNED AND DATED BY THE OWNER. \ 25-4 <br /> o <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFIC�{4 1 6!7 <br /> WHEN o + <br /> NEEDED. t�N <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. �� Z� - 'j <br /> CONDITIONS OF PERMIT: QpR p y�^ I P <br /> t <br /> ISSUANCE. <br /> MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF P&I N� 8 3 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELIN,QO CC)(J/V y L <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY N/NG 1V / J <br /> PERMITTED. �7 <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER J <br /> SETBACK AREA. _ <br /> 5. <br /> m 0) 0� M a� m <br /> 6. $ 3 & x �D <br /> v mcy � o � 3 <br /> 7. Z ymo <br /> P -n � A <br /> I declare that this application(including any accompanying schedule) has been examined by me and to the best of my Cn C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of a o v, <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o : mM <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- O <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 <br /> authorized person to access to the ove Ae§cribed premises at any reasonable time for the purpose of inspection. m m ? <br /> CD o : <br /> CD <br /> 0 <br /> SIGN HERE <br /> to in <br /> (signal a of owner or buil contractor) date i n <br /> ZONING ADMINISTRATOR <br /> N N <br /> Ea Ln fA r) 0 N <br /> N O O <br /> (lO tT N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />