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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v G) Z <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> y O <br /> OWNER` TELEPHONE J ,fes <br /> r wW (� m <br /> MAILINGADDRESS -76 3 6 �� � O <br /> 0 <br /> 1 <br /> PROPERTY ADDRESS 1�/ e' .� ° <br /> LEGAL DESCRIPTION(see tax receipt) O m <br /> a <br /> DWELLING/BUILDING 4 GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ (n ° <br /> TYPE OF PERMIT(S): n <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ P <br /> STRUCTURE/ADDITION USE: ° <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) (n 0 <br /> m <br /> BUILDING CONTRACTOR: <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 a <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p L <br /> ZI y 6 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m o \' <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m y \ <br /> NORTH(N). c7 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m o <br /> CENTERLINE OF ROAD,(C) BUILDING(S) MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF 1 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 1 <br /> BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. ry <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 0_ <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> 1 of <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN J <br /> NEEDED. <br /> I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z ^� <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. M O <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. J <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 0 W 0 Mo o <br /> C n, <br /> 6. m 3 o m x a ° p <br /> a o� <br /> 7. <br /> o, m M <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my G) c : 164: <br /> c <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application (including any accompanying schedule)and I further declare that I recognize m c v <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- ° rn <br /> G) : = : <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this informa ion m ° <br /> providing in this application. I agree to permit county officials charged with admin, to ' ' t. t e o (D <br /> authorized per to a access to thea ve cribed premises at any reasona"IA i t e m t ° n <br /> _ m <br /> m <br /> D <br /> SIGN HERE I' <br /> ( ' n ture of r or building contractor) APR (ba i <br /> ZONING ADMINISTRATOR <br /> BUfA fA fA b9 N <br /> ONOCn V• °10 <br /> TOWNSHIP PERMITS MAY BE REQUIRED ZONING O <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM D ,T``E OF ISSUANCE <br /> Pna.t �01 -�"D DP <br /> t�Rrd 4- nrn.R- Lpookn-/2 U-)a -bs <br />