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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator In 0? <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> n O <br /> N <br /> C <br /> N <br /> p T <br /> OWNER bona Id �5,ob a TELEPHONE <br /> �[ j O <br /> MAILING ADDRESS a r) {(�6) 7 m <br /> / � ® o <br /> PROPERTY ADDRESS a � T`�'-/ <br /> LEGAL DESCRIPTION(see tax receipt) �( t <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ U) <br /> TYPE OF PERMIT(S): n <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ Zn <br /> <. <br /> o <br /> STRUCTURE/ADDITION USE: (0- ' (J� <br /> (Home bin; Commercial Business; Bedroom; Deck; etc.) m 7 <br /> nS <br /> BUILDING CONTRACTOR: a <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 ~ CTo G <br /> ;0 N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 n <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m( f) <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE In Cn o <br /> NORTH(N). 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDINGm (SNS)TO � a <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF I o <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. IU <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(OF),AND ALL DISTANCES TO pp <br /> BUILDINGS,ROADS, LAKE,LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. Ir�t o <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS v\1 OJ <br /> MUST BE SIGNED AND DATED BY THE OWNER. O j <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN ° W <br /> 2 <br /> NEEDED. <br /> dW <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 <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 d <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. This structure to be used as Private residential <br /> 5. garage/storage only. Not to be used for human X m �; > o a o m <br /> habitation. CD 7 - R <br /> a N n ° <br /> 6. o m C o <br /> Z c m o <br /> o <br /> 7. m it's :- � � M m <br /> I declare that this application (including any accompduy,,,g awleuu--1 -y •••- and to the best of my i G'� c [ C <br /> knowledge and belief it is true, correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of W <br /> U0 <br /> all information contained in this application (including any accompanying schedule)and I further declare that I recognize m0 <br /> �Q <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> 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 m <br /> providing in this ap ication. I agree to permit county officials charged with administering county ordinances or other j <br /> authorized person have access to the above described premises at any reasonable e f t r f' ection. T Q <br /> m n <br /> SIGN HERE o <br /> (date) <br /> (sign ure of ow or wilding contractor) <br /> ZONING AD!HIS <br /> OR /' ' <br /> © ' <br /> O <br /> I N C W W N O <br /> TOWNSHIP PERMITS MAYBE REQUIINETT COUNTY G <br /> PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF W <br />