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Oun <br /> Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office oTLbAn1to(t{ NIPo �o <br /> APPLICATION FOR LAND USE PERMITS <br /> 67 0 <br /> Xj <br /> W1 y V - <br /> / <br /> OWNER �� C <br /> / TELEPHONF� LL � o <br /> CD <br /> MAILING ADDRESS <br /> m <br /> � o <br /> PROPERTYADDRESSc�2 g } <br /> LEGAL DESCRIPTION(see tax receipt)s a <i <br /> 0 <br /> DWELLING/BUILDING GARAGE/A CESSORY STRUCTURE ❑ AD (TION ❑ c <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ C MPING UNIT ❑ SU BDIVISI ❑ <br /> 0 <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business;BUM; Deck;etc. m <br /> 2. <br /> A� <br /> BUILDING CONTRACTOR: , Or m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O G <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> 71 <br /> ?r O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 m � <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m F <br /> C O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m \v <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 /> 5. 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 �J 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. 1 to f <br /> Q v 0 <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. o ) <br /> CONDITIONS OF PERMIT: <br /> r <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <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 \ ry <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. 1c/` rDCDO -0 <br /> N 3 j (OD O a f m <br /> 6. �. C m �c T. 'a <br /> "4 N C <br /> Z y O O <br /> 7. o -n� : m <br /> _ rn : A <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my L7 c C <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of m 0 .n <br /> C1 v A <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o <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 m <br /> providing in this a lication. I agree to permit county officials charged with administering county ordinances or other <br /> authori to have acce the above sc ' d premises at any reasonable time for the p pose f inspection. T ° o <br /> � m <br /> SIGNHER a <br /> nure o it mg contractor) late) <br /> ator <br /> NO <br /> t <br /> ZONING ADMIN A R <br /> O Ut 000 <br /> TOWNSHIP PERMITS MAY BE REQUIRED C <br />