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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 /> r <br /> N O <br /> N <br /> CD <br /> C <br /> OWNER —roe.rS O� TELEPHONEeL2 e9o <br /> J�� `/ - h tt4F- f <br /> MAILING ADDRESS A ��(�� YV /' C � � �® � �ry e �� � <br /> PROPERTYADDRESS Al <br /> 1 <br /> LEGAL DESCRIPTION(see tax receipt) <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE X ADDITION ❑ ` V> <br /> TYPE OF PERMIT(S): <br /> D'eQ1— a <br /> FILLING/GRADING ❑ CAMPING UNIT 11 SUBDIVISION ❑ S. <br /> �rtt �'G�91� a� �� N <br /> STRUCTUREJADDITIONOSE: + / �2GX- 0 <br /> (Home/Cabin; Commercial Busine ;Bedroom; Deck;etc.) ori <br /> 2 <br /> BUILDING CONTRACTOR: <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 r <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> M N V <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> n <br /> ?i Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m v <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <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 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF I \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 C <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 3 <br /> MUST BE SIGNED AND DATED BY THE OWNER. O ) <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. n <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> C <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT �J <br /> ISSUANCE. (I ) <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. �U <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 /> o 3 cL iu 8 gnf m ;Um <br /> ya <br /> 6. C N N O <br /> 7. o m T2 : _ � ;a <br /> A <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G)c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of d 0 : .n <br /> n i : c : <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize : O 0 <br /> that this information 1 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 m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <br /> authorized person to have access tot a above described premises at any reasonable time for the purpose of inspection. ° o <br /> CD <br /> SIGN HE <br /> (signature o er or buil cont to) (date) - <br /> ZONING ADMINISTRATOR <br /> (� (A 0 NNfA E 0 N <br /> 'wvr NNOO <br /> (T OUCI100 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />