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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator v G) Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> 1 ni� y O <br /> C V <br /> OWNER ^ C TELEPHONE <br /> Sm ` <br /> MAILING ADDRESS �j/ O <br /> 7` f <br /> r � <br /> PROPERTYADDRESS 3m 12c i x42PR. C^ <br /> C$ V 1 <br /> O <br /> LEGAL DESCRIPTION(seetax receipt) u11 2 a/�� ,�pT? <br /> CJ t <br /> DWELLING/BUILDING <br /> TYPE OF PERMIT(S): GA,RAW DRY STRUCTURE X ADDITION ❑ �o' <br /> f�f� <br /> FILLING/Mo . CAMPING UNI SUBDIVISION F-1 <br /> STRUCTURE/ADDITION USE: <br /> o' <br /> ome/Cabin; Commercial business: <br /> Bedroom; Deck;etc.) y <br /> ' <br /> m <br /> BUILDING CONTRACTOR: ?. <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. TO 3 3 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 <br /> O m <br /> T a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T Z <br /> o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m :bNORTH(N). <br /> m <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m (`(� c <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF v ( R' ' <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. Ul <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <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. o p✓ <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. qj <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z T <br /> CONDITIONS OF PERMIT: o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT w <br /> ISSUANCE. ( R� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY I <br /> PERMITTED. n <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER (w„ <br /> SETBACK AREA. <br /> 5. <br /> 6. m moro <br /> �a0 � <br /> $ 3 nm '0 a' m <br /> 7 <br /> Z N N O O 'o -{ <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my — p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of .� d n v, C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognizem E 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 o the County of Burnett relying on this information I am <br /> providing in this application. 1 agree to permit county offici charged with administering county ordinances or other <br /> authorized person to have access to the above described ises at ny reasonable time for the purpose of inspection. (n <br /> -n o : <br /> SIGN HERE �/ m <br /> o <br /> signature of ow r ullding contractor) a <br /> (date) <br /> ZONING ADMI RATOR Q ': <br /> in fA fA W <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />