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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 E3 <br /> N r <br /> N <br /> �\ n <br /> OWNER 4jAW TELEPHONE01 <br /> S <br /> m <br /> MAILINGADDRESS I �7 <br /> r <br /> o <br /> �P/ROPERTY ADDRESSC->ak <br /> ` <br /> N <br /> LEGAL DESCRIPTION(see tax receipt) /�7 <br /> P <br /> DWELLING/BUILDING1:1 GARAGE/ACCESSORY STRUCTURE X ADDITION ❑ &A-tots (n o <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ElCAMPING UNIT ElSUBDIVISION <br /> /. ```A ❑ Y N: <br /> STRUCTURE/ADDITION USE: 'Q A i 4--�o 0 c , <br /> (Home/Cabin;C mer lal usiness;Bedroom; D ck;etc.) (n <br /> m <br /> t 0 nvas�i,L <br /> BUILDING CONTRACTOR: 19C� <br /> v <br /> 42m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR B. <br /> =ZONS!F�®RPLOT <br /> PLOTANS WILL BE p <br /> WING: A <br /> (AERIAL OR TOP VIEW OT n �\ <br /> -n O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). (a <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m3 <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. <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 /> S. 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 0. a <br /> MUST BE SIGNED AND DATED BY THE OWNER. CD <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VE1 — <br /> NEEDED. �l <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. �� JUN.� I <br /> 2w U <br /> o <br /> CONDITIONS OF PERMIT: / <br /> 1 <br /> ISSUANCE.MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF RWRIVETT COUNTY <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINLZONING <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY C� <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> t�i� <br /> 7 Z who : � <br /> . � 1 <br /> o :n Q <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my cj C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m to <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize ma <br /> that this information I 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 v . <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized perso have cess to tW above described premises at any reasonable time for the purpose of inspection. o <br /> SIGN HERE <br /> (s gnature owner r building contra r) (date) <br /> ZONING ADMINISTRATOR <br /> ti NN N O O <br /> G N P(T O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 1111 <br />