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Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator vG) Z <br /> APPLICATION FOR LAND USE PERMITS 3 ° <br /> 0 <br /> OWNER /S— <br /> y /c /CC C��5 a� TELEPHONE i �l6 <br /> MAILINGADDRESS 7G 0 <br /> _ f <br /> / r m <br /> PROPERTYADDRESS / �1 / ° <br /> I �— <br /> LEGAL DESCRIPTION(see tax receipt) 16 C c �{/ Al e `, /� e//DC� �64 <br /> t� ! V tLl V l ( w` C <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION <br /> f m <br /> TYPE OF PERMIT(S): 1�,1 �j c <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ v" a ,�,� <br /> STRUCTURE/ADDITION USE: <br /> gx IS t U a. � e n <br /> / (Home/Cabin; Commercial Business;Bedroom; Deck; tc.) <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/x X 77 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. .n 3 <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) ;a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. -n a z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m o <br /> NORTH(N). <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 v <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. \ Z <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. p s _ <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 1✓ ��.� �V <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS ° d <br /> MUST BE SIGNED AND DATED BY THE OWNER. 3 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN 1 o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. ) <br /> CONDITIONS OF PERMIT: Z <br /> o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT J <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. mmV mM0MCLFm <br /> 2 <br /> 7. 4 ID <br /> m C0 N N 0 <br /> Z N �D O ° <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my o m p <br /> _� m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of w, m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to is- 0 <br /> m <br /> sue a permit. I further accept all retwhich may county <br /> a result the County of Burnett relying on this information I am d <br /> providing in this application. I agree e too permit county officials c charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> -n 0 : <br /> O . <br /> SIGN HERE (e�1 <br /> (Signa re of ner or building contractor) ' <br /> (date) n <br /> ZONING ADMINISTRATOR <br /> r l - 1 $073� & r4� <br /> pwo ��oo <br /> TOWNSHIP PERMITS MAY BE REQUIRED0 ��.pso � IgDaB <br />