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Burnet[County 7410 Co. Rd. K, No. 102Siren,WI 54872 Office of Zoning Administrator vO Z <br /> APPLICATIONFOR LAND USE PERMITS 3. �� 'y <br /> N <br /> �lJ <br /> N <br /> C <br /> OWNER <br /> TELEPHONE � <br /> o <br /> d <br /> MAILING ADDRESS F <br /> CD <br /> CD <br /> � o <br /> PROPERTYADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) —1q %vw/,/ / CID� <br /> TYPE OF PERMIT(S): <br /> DWELLING/BUILDING F1GARAGE/ACCESSORY STRUCTUR 11ADDITION ❑ Cj c o <br /> FILLING NG L-1C CAMPING UNIT UBDIVISION <br /> /G c�"� —��f✓ <br /> C < <br /> STRUCTURE/ADDITION USE: J}-n o' <br /> ( ome/Cabin; Commercial Business; Bedroom; Deck;etc.) in <br /> BUILDING CONTRACTOR: <br /> m <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/:X 71 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. n <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O <br /> -n <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. � <br /> n d � <br /> 2. SHOW THE LOCATION AND SIZE OF ALL E USTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m a <br /> NORTH(N). C n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLL WING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <br /> CENTERLINE OF ROAD,(C)BUILDING(S)M ASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF Z <br /> LAKE,STREAM OR RIVER AND MEASURE ENT TO WETLAND AREAS. o <br /> 4. SHOW THE LOCATION OF THE WELL(W), EPTIC 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 ikN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS ISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P <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. I D <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. <br /> 6. m W n MO o f M <br /> 3 am Oaa ;a <br /> 7. Z y 0 O : ?U 3 <br /> T� �I <br /> I declare that this application (including any ac ompanying schedule) has been examined by me and to the best of my _ - A <br /> knowledge and belief it is true,correct and com Mete. I acknowledge that 1 am responsible for the detail and accuracy of m �, v, C <br /> all information contained in this application(inc uding any accompanying schedule)and I further declare that I recognize C o m <br /> that this information I am providing will be retie I upon by the County of Burnett Wisconsin in determining whether to is- O <br /> 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 �: w <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. ? <br /> o : <br /> m m <br /> SIGN HERE <br /> (signature ner building contractor) (date) <br /> ZONING ADMINISTRATOR <br /> N <br /> ME1NA 69�N <br /> N NO O <br /> (.n OfJ <br /> TOWNSHI PERMITS MAY BE REQUIRED (TOO <br />