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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator - o c <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> CD <br /> OWNER 11 GL�YI �I�; C "/w TELEPHONE <br /> Q " ��j <br /> MAILING ADDRESS �l 1^!2 CD CDr <br /> 0 <br /> PROPERTYADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) IU/A Al <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑6� / cn ` <br /> TYPE OF PERMIT(S): rr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin Commercial Business;Bedr o�k;etc.) (n <br /> BUILDING CONTRACTOR: <br /> TI <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3� } <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 4 M <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). y op , <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. G. <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 AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> 0. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o l� <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT C <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. �l <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 /> M ng ads £ m <br /> 0 3 nm Fam <br /> 6. m <br /> O N C y y 0 <br /> N N O O 1 <br /> 7. O T M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Zj Cr a c C <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of d 0 v, <br /> n ^ : cn : � <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize m 0 : mo <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- Y <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 D+ <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. ° o <br /> CD <br /> CD m' <br /> � m <br /> SIGN HERE a <br /> (signature of owner o 'Iding contractor) (date) <br /> � - <br /> ZONING ADMINISTRATOR <br /> to fA to to N <br /> (� N) nNN00 <br /> (T OOI (TOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />