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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator -0 G) Z <br /> APPLICATION FOR LAND USE PERMITS 3 ° <br /> 0 <br /> o <br /> 41 <br /> /� ,{ L /, <br /> ovvNER 1 // / 7`t`! /� i,�'J C /-) TELEPHONE ` <br /> MAILINGADDRESS Q L Y 1 V <br /> PROPERTY ADDRESS �"' '-r ' ° <br /> LEGAL DESCRIPTION(see tax receipt) ? 9 - la 0 / T3 g l� <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ �(�jl - ^� 'vV o <br /> TYPE OF PERMIT(S): 0 <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ Q <br /> [� a <br /> 62 <br /> STRUCTURE/ADDITION USE: T x / y <br /> (Home/Cabin, Commercial Business;Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: <br /> m " <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T 3 <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) A <br /> O m <br /> -nG <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE v <br /> NORTH(N). M <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 <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. Z <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO o <br /> BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. Q) <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTTC., THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICA N MAY�4� q <br /> NEEDED. V T o <br /> O <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. J ��� , v <br /> CONDITIONS OF PERMIT: BUgN�� 0 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ZQr C / O <br /> ISSUANCE. 'Y A'A' 'Y <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. NC <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. <br /> m d� 0MaFrtml <br /> 7. N CL <br /> C y O j' 3 <br /> Z N N (2 <br /> I declare that this application (including any accompanying schedule) has <br /> T <br /> been examined by me and to the best of myi JD <br /> o � m <br /> =cn, m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of d a, C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize C o m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- am ' 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 <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. y <br /> -n o : <br /> CD <br /> SIGN HERE <br /> • 7- lD - a 3 � �, : <br /> (signatur owner building contractor) (date) Cl <br /> ZONING ADMINISTRATOR <br /> 14 eqnIC422Q <br /> Ea fA N <br /> (Nii O(NT tNiO O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />