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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator T L) Z <br /> APPLICATION FOR LAND USE PERMITS <br /> o 73 <br /> OWNERY �rA I ' "( �'` TELEPHONEp <br /> ^\ L ^ m O <br /> MAILING ADDRESS �,g � _ ...Yi Z P��t C r,�l o <br /> PROPERTYADDRESS O o <br /> LEGAL DESCRIPTION(see tax receipt) 3S o <br /> V N <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITIONo <br /> TYPE OF PERMIT(S): Cn C 0 <br /> Q <br /> FILLING/GRADING CAMPING UNIT ❑ SUBDIVISION a <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) C, <br /> tt � <br /> BUILDING CONTRACTOR: (i l d <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. _n <br /> O <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n W ? <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> M m <br /> NORTH(N). C O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO m - 0 <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. o <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. <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. <br /> o <br /> O0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a o ' n <br /> NEEDED. l� 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED 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. <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 c: Wm0M * m <br /> o > > o o a <br /> m �c3 am �c ^: cD .-0 <br /> 00 02 o 3 <br /> 7. Z c y m o <br /> P m : Tom : m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of my A <br /> PP ( 9 Y ) Y <br /> knowledge and belief it is true, correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of m c <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize m C : m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to �is- m0C: <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 : o <br /> providing in this application. I agree to permit county officials charged with administerin I count nances or other ° I D) <br /> authorized person to have access to the above described premises at an t inspection. <br /> T 0 <br /> SIGN HERE /q m a <br /> v <br /> (signat a owner o -ding contractor) OF (d ) ' i j <br /> ZONING ADMINISTRATOR - SEP 3 20 <br /> 0 (A(A(A(A(A N <br /> ETT COUN*3D( ' O N 0 W 0 N O <br /> T NSHIP PERMITS MAY BE RE 989 <br /> 0 n o cn cn n o <br /> THIS PERMIT HALL EXPIRE ONE YEAR FROM DATE SU9NCE v <br />