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Burnett County 7410 Co. Rd. K, No. 1(2, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATIC N FOR LAND USE PERMITS _ <br /> 3 r XJ <br /> O <br /> OWNER <br /> r I I V" lW TELEPHONEo- <br /> /� d [ [ o <br /> MAILING ADDRESS D10D1,etr' ,,/g0 r O <br /> PROPERTYADDRESS e /� (Q J D <br /> 5.4(p T. '40 RI4w � <br /> LEGAL DESCRIPTION(see tax receipt) PC 0 t/ (-0 f 3 <br /> ( N <br /> TYPE OF PERMIT(S): DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION <br /> y o <br /> c <br /> FILLING/GRADING D CAMPING UNIT ❑ SUBDIVISION ❑ Cr <br /> 0 <br /> STRUCTURE/ADDITION USE: P`iK N. <br /> ( ome/C—ab in; Commercial Business; Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: S'e � 0 <br /> m <br /> d <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEA T AN 8'/2 X 11 SHEET OF PAPER. ANY INCOMPLETEOR CD <br /> v <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m 9 <br /> DIRECTIONS FOR PLOT PLAN DRAWING.. (AERIAL OR TOP VIEW) O <br /> C <br /> I. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. -n a <br /> 2. SHOW THE LOCATION AND SIZE OF ALL ISTING BUILDINGS (EB)AND ALL NEW BUILDINGS(NB)AND INDICATE Z <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 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)N EASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <br /> LAKE,STREAM OR RIVER AND MEASUREI IENT TO WETLAND AREAS. o <br /> 4. SHOW THE LOCATION OF THE WELL(W), EPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO Z <br /> 0 <br /> BUILDINGS, ROADS, LAKE, LOT LINES. <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BYAN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE PLANS N <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> 0 1 <br /> NEEDED. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 61 <br /> CONDITIONS OF PERMIT: Z <br /> 0 0 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT I <br /> ISSUANCE. n <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. N <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. <br /> M 0 1— > > O <br /> m W d 0 M O. F m <br /> 7. .o mCNyOS' �s <br /> Z CD 7a —II declare that this application (including any acc mpanying schedule) has been examined by me and to the best of my O m� p <br /> knowledge and belief it is true, correct and comp ete. I acknowledge that I am responsible for the detail and accuracy of d m <br /> all information contained in this application(inch.ding any accompanying schedule)and I further declare that I recognizeCDo <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- ° 0 <br /> sue a permit. I further accept all liability which y be a result of the County of Burnett relying on this information lam <br /> . <br /> providing in this application. I agree to permit c unty officials charged with administering county ordinances or other L7 <br /> authorized perso o ave access to the ve de cribed premises at any reasonable time for the purpose of inspection. <br /> m to <br /> O <br /> SIGN HERE m <br /> (signature of ner or it ngcontractor) <br /> (date) a <br /> ZONING ADMINISTRATOR <br /> w f» <br /> 69 69 fA fA � N <br /> TOWNSHIP PERMITS MAY BE REQUIRED �� t� 0 0 fil 0 0 <br />