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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 O z <br /> APPLICATION FOR LAND USE PERMITS 3. 9�(� <br /> y O , <br /> N <br /> C <br /> (D <br /> Q <br /> OWNERO TELEPHONE _ o <br /> m <br /> m <br /> MAILINGADDRESS v O <br /> o <br /> PROPERTYADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) S� U <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ \ (n <br /> TYPE OF PERMIT(S): Q <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n O <br /> N <br /> STRUCTURE/ADDITION USE: acla 0._�j,s�-��\ O, A. Q O' 4 _ n bo \ <br /> (Home/Cabin; Commercial B iness; ed room; Deck; etc.) rn <br /> BUILDING CONTRACTOR: �� L E; 1 <br /> �Y <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O — C <br /> W N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n a <br /> n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m L z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). y C o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF f Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. e P <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO J <br /> BUILDINGS, ROADS, LAKE, LOT LINES. l O <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. a N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR,ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. J <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 V <br /> SETBACK AREA. <br /> 5. <br /> X c� m ori a £ T <br /> 6. m x 3 m m m p <br /> 0 o m co7. 3 <br /> Z c in N o <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m — r^ A <br /> PP (� 9 Y ) Y Y �` G) � � C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of o �_ <br /> all information contained in this application(including any accompanying schedule)and i further declare that I recognize m c o <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- rn <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 permit county officials charged with administering county ordinances or other d <br /> authorized person to have s to the above described premises at any reasons I I c n. m i 'a <br /> D <br /> a <br /> SIGN HERE En o <br /> (signature of oflntr oIr building contractor) (date) 0 <br /> 1 OCT 1 2 2004 <br /> ZONING ADMINISTRATOR E <br /> o �'<n tnw<n vi <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> BURNETT COUNTY 0 CA a N N NpJ <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSAkkNG <br />