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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator 'o o o <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> N ` ^ <br /> C <br /> M <br /> OWNER TELEPHONE p � <br /> CD <br /> MAILING ADDRESS <br /> r � <br /> 0 1` <br /> PROPERTYADDRESS <br /> Sitll'�' /� '_ <br /> LEGAL DESCRIPTION(see tax receipt) � �^ 4-- ( r <br /> Q <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE El ADDITION CA o <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING 1:1 CAMPING UNIT ❑ SUBDIVISION <br /> C J( OC/ c <br /> STRUCTURE/ADDITIONOSE: � <br /> Home/Ca in;CoTnmercial usiness;Be oom; Deck;etc.) U) <br /> BUILDING CONTRACTOR: L <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 17 SHEET OF PAPER. ANY INCOMPLETE OR .n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 a <br /> c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n Q. --5� <br /> '—r o Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m X <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C 0 <br /> NORTH(N). 3 <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. 1 <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. o <br /> 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. f <br /> v � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN ° <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 0 4 <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. N J <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 C). <br /> SETBACK AREA. <br /> 5. <br /> m epi W 0MCL M <br /> W <br /> 6. m c N y o S 3 <br /> y O O U3 i <br /> 7. °° -n m a <br /> ti: : . L7 <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ` ����,', G)2 : : C) <br /> knowledge aCL <br /> nd belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of W: @ <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m my <br /> that this information 1 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 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. -n ° '. o <br /> M <br /> SIGN HERE <br /> (signature of ow r o ui[ding contractor (date) (� <br /> ): <br /> ZONING ADMINISTRATOR <br /> (O, EA fA(A M 0 N <br /> (]v`-t/ NCTN NOO <br /> CTO(T (T O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />