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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m o° o <br /> APPLICAT N FOR LAND USE PERMITS <br /> r <br /> C <br /> r � <br /> OWNER <br /> TELEPHONE <br /> / O <br /> MAILINGADDRESS ` / <br /> m <br /> 1 <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) <br /> 3q ie/hl <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ <br /> TYPE OF PERMIT(S): n <br /> FILLING/ ADING CAMP G U IT ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITION USE: , <br /> &ome/(-aqq <br /> bin; Commercial Business; Bedroom, Deck, etc.) <br /> BUILDING CONTRACTOR: <br /> m zs <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR TO 3 <br /> W <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. y <br /> O a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n <br /> T Z <br /> n w <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. X <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> rn n <br /> NORTH(N). m ° <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO m �o <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> o � W <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> o <br /> NEEDED. <br /> z I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. ° <br /> CONDITIONS OF PERMIT: ri <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT O <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. (w'` <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> Z7 W nr DODO -0 <br /> 5. m cmmr, m °- f m <br /> ° 3 a2 <br /> Z <br /> c m T o ° q <br /> O ry 2i m <br /> 7. EE rA i <br /> sA <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my cj� 4� : c <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m <br /> all information contained in this application (including any accompanying schedule)and 1 further declare that I recognize <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m o <br /> sue a permi further accept all liability which y be a result of the County of Burnett rel iam <br /> n on this informato n ther vv <br /> m <br /> providing ' thi applic I agree to permit my officials charged with a <br /> r e e ion. T n <br /> authoriz d pers n to hav ess to the ab ve a ribed premises at any rea 1 CD m a <br /> y� a <br /> SIGN H0 J 2 R 20b) ° <br /> ( na re of ow or building contractor) U L CUOJ <br /> ZONING ADMINISTRATOR BU "'. . . . r� <br /> O N (TW W N O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> ZONING � `� 0 `� `� `� 0 <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />