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Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator _U G) Z <br /> APPLICATION FOR LAND USE PERMITS _3� - <br /> r <br /> y O 'N <br /> OWNER m r^ r I e (1,00 TELEPHONE <br /> v <br /> d <br /> �' Sf '? '? ati�Oc. r c� �3L� 0 <br /> MAILING ADDRCD <br /> ESS p <br /> PROPERTYADDRESS <br /> C/ r <br /> LEGAL DESCRIPTION(see tax receipt) GI S��y 1 - LJ I� I (� p I <br /> t 1 I `(� m -r <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ o <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING CAMPING UNIT/❑ UBDIVI O <br /> Cr <br /> 3 <br /> STRUCTURE/ADDITIONUSE: — ^,3 j- o <br /> n• (Home/Cabin; Commercial Business;Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: <br /> z � <br /> r <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 m <br /> n m <br /> T n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T Z <br /> ATE <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m O <br /> NORTH(N). ~° <br /> n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. Z <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO 9 <br /> BUILDINGS,ROADS, LAKE, LOT LINES. C�5 <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N p <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS 0 �l J <br /> MUST BE SIGNED AND DATED BY THE OWNER. 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o V� <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: p t7 <br /> Iv <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT C <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 /> 5. <br /> 6 m � D O D O -V <br /> 8 3om21— <br /> Ox <br /> 7. v N w <br /> Z y N O 0 <br /> O T G <br /> I 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 accuracyof p ` ' S <br /> all information contained in this application(including an accompanyingschedule and I further declare that I recognize fe- m o m <br /> PP ( 9 Y ) g <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 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. M <br /> m ti : <br /> -n 0 <br /> CD <br /> o : <br /> SIGN HERE <br /> m m : <br /> t» iu <br /> (si atur of owne b ding contractor) a i <br /> (date) <br /> ZONING ADMINISTRATOR ^� <br /> G vi to <br /> N N N N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />