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Burnett County 7410 Co. Rd.K, No.102,Siren,WI 54872 Office of Zoning Administrator - 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> OWNER ` TELEPHONE <br /> MAILING ADDRESS <br /> SIM 11P/ O <br /> PROPERTY ADDRESS r <br /> Co CJid©()Iye k-' <br /> LEGAL DESCRIPTION(see tax receipt),5e�r 16N U)✓ / V m <br /> ❑ G�!-,c�5 y� <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION y o' <br /> TYPE OF PERMIT(S): n <br /> FILLING/GRADING ❑ f�MPING UNIT 11 SUBDIVISION ❑ <br /> rh <br /> STRUCTURE/ADDITIONUSE: a.lWi,¢--G° p� �j�J o <br /> (Home/Cao;Commercial Business; Bedroom; Deck;etc.) y <br /> BUILDING CONTRACTOR: _l <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 9 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n z <br /> M <br /> m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p m <br /> n a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C <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 Z <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. O <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. 0 <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N 9� <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. o <br /> o F <br /> O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN Fft o <br /> NEEDED. <br /> 2 4— <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P (� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT JZ <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 /> 6. m y� >0 Q 017 <br /> m <br /> :E3 (D x <br /> N C y N O <br /> 7. Z N M00 <br /> O -n`< ;tl <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my —�' p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofd n v, C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize d 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- m <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 d <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized <br /> person ave access t t ve described premises at any reasonable time for the purpose of inspection. '^ <br /> T O <br /> CD <br /> CD <br /> SIGN HERE � � <br /> (sl <br /> t of ow buil g tractor) <br /> (date) <br /> ZONING ADMINISTRATOR <br /> O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED O N <br />