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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator ci z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> UT 0 <br /> CD <br /> OWNER <br /> TELEPHONE <br /> 1 '+ <br /> MAILINGADDRESS <br /> r m <br /> 0 <br /> PROPERTY ADDRESS <br /> dLEGAL DESCRIPTION(see tax receipt) <br /> 6 m <br /> ❑ <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE El ADDITION ooa <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISIO ✓J` �/ a a <br /> STRUCTURE/ADDITION USE: _ �. S I'Yl I/ N P� / q�/ `0 <br /> 0 <br /> (Home/Cabin; Commercial Business;Bedroom; Deck;etc.) ti <br /> dBUILDING CONTRACTOR: La- �_Sr/,��/Z iu <br /> 1 <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR CD3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> O <br /> A N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> -n a <br /> n z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> A m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 033 <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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N W <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 /> � F 1 <br /> o I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN O <br /> NEEDED, 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. oz o' <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. 111*4 <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. V <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 6. m <br /> Wm r,- S)a 0 <br /> 7 (D C N y O = <br /> Z N n1 O f0 <br /> n z �1 <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m n d, c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize 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- O <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 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. cn <br /> - o : <br /> m m <br /> SIGN HERE <br /> n : <br /> (signature of owner uil ing contractor) (date) r <br /> ZONING ADMINISTRATOR <br /> di di fR 1A N <br /> r. NUN NO O <br /> Ut O [T <br /> TOWNSHIP PERMITS MAY BE REQUIRED V 0 O <br />