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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator -U 0 Z <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> N <br /> 0 <br /> N Q <br /> n <br /> CD <br /> OWNER �Q I� J~ >4 E�S E TELEPHONE <br /> d <br /> MAILINGADDRESS ,{`�/� �� �� 1� J� / <br /> r m <br /> o <br /> �— <br /> PROPERTYADDRESS - <br /> LEGAL DESCRIPTION(see tax receipt) �_ SSG✓ / �, \• <br /> m <br /> DWELLING/BUILDING �I GARAGE/ACCESSORY STRUCTURE R1 ADDITION N 0 <br /> TYPE OF PERMIT(S): Q <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> STRUCTURE/ADDITION USE: o <br /> (Hoyng/gabin; o mercial Business; Bedroom; Deck;etc.) C <br /> (fCJ/ EG�(SnJ, a <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/x X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> M <br /> w <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 p � <br /> n a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m B <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. 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 Q 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. 0 1 <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION.M/"�9E DQNE WHEN n S <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. —� o <br /> CONDITIONS OF PERMIT: V P <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PE IT 2 Q � <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORE�LINEE..NETT COUNTYn I <br /> 3 NO GRADINGMITTED. OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY ZONING O <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 6. m 3 ' m 0 n F m <br /> A <br /> O N C H N p 5- <br /> 7. <br /> 7. Z N (—D <br /> � �7 <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my �j A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of d C e, C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognizeao E 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 liability which may be a result of the County of Burnett relying on this information I am o <br /> providing in this application. I agree to per"county officials charged with administering county ordinances or other <br /> authorized person to have access to the ov described-premises at any reasonable time for the purpose of inspection, . ; s <br /> -n o : <br /> CD <br /> SIGN HERE n <br /> �— l e fA <br /> (signat o o er or building contractor (date) o. <br /> ZONING ADMINISTRAT ' r /� �1�� <br /> EA EA EA fA � N <br /> N <br /> 0 N N O O <br /> V O U N O O <br /> TO SHIP PERMITS MAY BE REQUIRED <br />