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Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator - ° o <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> 0 N <br /> / ^- d <br /> CD <br /> OWNER (6_ Ifte- TELEPHONE �6� �cJIL/ 1 -C4 p <br /> MAILING ADDRESS V <br /> m <br /> Fr� 5t <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) L j�t S 3 S!7 ` — (CJo? M <br /> n� <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION <br /> TYPE OF PERMIT(S): <br /> FILLING/Gj2ADING ❑ CAMPIIJ�; UNIT ❑ SUBDIVISION ❑ <br /> //If(QJ ( m S 100 <br /> STRUCTURE/ADDITION USE: (ti <br /> (Home/Cabin; Commercial mess;Bedroom; Dec etc.) ,� XJ <br /> BUILDING CONTRACTOR: S 2 <br /> Oa <br /> v <br /> M <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. <br /> oCD <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) a <br /> m <br /> In v z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n <br /> m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C O o <br /> NORTH(N). to <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF d o <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. y Q <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO b <br /> BUILDINGS,ROADS, LAKE, LOT LINES. V <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED Ol�FILLED. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER�Cojl�' <br /> CO TRACTOR, ETC.,THE PLANS ? <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> �ppll�llJ0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERT, TIO 9�1�e <br /> DONE WHEN <br /> oNEEDED (THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW � o <br /> CONDITIONS OF PERMIT: 2 17 _ T <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF <br /> ISSUANCE. n^.I \ �, <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORII' � j. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY �� / W <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED <br /> PERMITTED. aWATEV <br /> SETBACK ARE <br /> �Ij 3 L xaV. ry <br /> 6. mCNoZo�. ° — ` <br /> _ � : A <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my T <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of c o IA71 <br /> application(including an accompanyingschedule and I further declare that 1 recognizeCD <br /> all information contained in this app' 9 Y ) <br /> that this information 1 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 m <br /> providing in thisNpplication. I agree to permit county officials charged with administering county ordinances or other ,p <br /> authorized pe to have access to the abo d scribed premises at any reasonable time for the <br /> 'purpose of inspection. m o <br /> CD <br /> V <br /> ) 33 �' a C <br /> SIGN HER <br /> (signs of owner or building co tor) ( te) ; I <br /> ZONING ADMINISTRATOR (? fn to E» N <br /> /( N j e.d (TNN O <br /> O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> -J <br />