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Burnett County 7410 CO. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. =- <br /> 7c$ <br /> N 0 <br /> N <br /> C <br /> OWNER TELEPHONE / - <br /> MAILINGADDRESS WWW <br /> PROPERTYADDRESS 8 t. <br /> LEGAL DESCRIPTION(see tax receipt) �e & _ 3 5 C, //M' <br /> r <br /> CD <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION ❑ ° <br /> TYPE OF PERMIT(S): v ' <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: / lv L 0 <br /> ( ome/Cabin;Commercial Business;Bedroom; Deck;etc.) cn <br /> m <br /> BUILDING CONTRACTOR: S� <br /> m <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEA T AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 J. <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. /y/rj� -n <br /> 0 m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AER AL OR TOP VIEW) O n <br /> In <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. i7 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL OUSTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). y o <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. P <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. I.pt <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. I IN 1� <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE PLANS CIO 0 <br /> MUST BE SIGNED AND DATED BY THE OW ER. o (`n <br /> v � 1rTV.r <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN y- o <br /> NEEDED. 2 j <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. Q� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. CJQ (), <br /> 3. NO GRADING OR SHORELAND ALTERATIO14S ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. C <br /> 4. NO STRUCTURES, INCLUDING RETAININGWALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> M <br /> 0r- 0Qvv <br /> m0 CD <br /> 6. 3 nm xn A <br /> o m C y m 0 = 9 <br /> 7. Z w O 1 <br /> o -n Q ;tl <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c C <br /> knowledge and belief it is true,correct and corr plete. I acknowledge that I am responsible for the detail and accuracy of � � ) <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize `�" m o Im <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m <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 application. I agree to permil county officials charged with administering county ordinances or other d <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. mCD o <br /> CD m' <br /> SIGN HERE (J / "' <br /> n : <br /> (sign ir b ilding co r) (date) ; <br /> ZONING ADMINISTRATOR /LTi <br /> fA EA fA EA � N <br /> N Ut N N O O <br /> P (T O N fT O O <br /> p �,r— TOWNSHI PERMITS MAY BE REQUIRED <br />