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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator - o o <br /> APPLICATION FOR LAND USE PERMITS ;V f- <br /> ur <br /> N <br /> \ d <br /> p1MJER o O <br /> J, m <br /> MAILING ADDRESS ()—Sf�a JE�/' • �� i ��7 (' m <br /> r ul <br /> PROPERTY ADDRESS � <br /> LEGAL DESCRIPTION(see tax receipt) �D/ <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ vl C C <br /> TYPE OF PERMIT(S): c <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ S. <br /> STRUCTURE/ADDITION USE: a� + � ^ o <br /> (HomelCabi ; mm rcial u iness;Bedroom eck; tc. jidt d <br /> BUILDING CONTRACTOR UUP2. <br /> foil �� -P�It ° <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 0,X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> X1 N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> T <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). C 0 <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 Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <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. ry p\ <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED Oh <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CON � <br /> PLANS d 0_ <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICq ION Mq�BE DONEIN ° <br /> NEEDED. R A <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. U NF V o <br /> CONDITIONS OF PERMIT: �C C <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 2D^IING Ul fin, U, <br /> ISSUANCE. v J <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. U✓ <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY P i C� <br /> PERMITTED. �1 <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. //���— ��� <br /> L7t CD W r0 MDaOv <br /> d <br /> 6. 8. 3a� xaaM <br /> -a m Cy ^ o 3 <br /> Z n o <br /> 7. ° -n` m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G) c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of iu 0 (A <br /> n v M <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize O 0 <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 liabAlity which may ar It of the County of Burnett relying on this information I am m <br /> providing in this app' n. I agr perm <br /> tc it co 0 1 gals charged with administering county ordinances or other <br /> authorized person ave ccess tprtl,4ove clec remises at any reasonable time for the purpose of inspection. T fD o <br /> c � <br /> N <br /> l y, pl <br /> SIGN HERE n <br /> (slg at f own or bu Idl ntractor) (date) <br /> t [ i <br /> ZONING ADMINISTRATOR ® v1 to <br /> fA EA fA d1 N <br /> Q N (T N NOO <br /> (> U O (T TOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED `�5��3 V/nq/ <br /> IU W5 <br />