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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS CD. <br /> N <br /> OWNER TELEPHONE ! 1 O <br /> ^ {� t_ m �v,J` <br /> MAILINGADDRESSy` 4� C� \\� 4 <br /> PROPERTYADDRESS6(4 <br /> L <br /> LEGAL DESCRIPTION(see tax receipt) I�i a A ,J c <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE lT ADDITION O <br /> TYPE OF PERMIT(S): � E] n <br /> FILLING/GRADING CAMPING UNIT ❑ SUB I I N � <br /> STRUCTURE/ADDITION USE: 0 <br /> (Home bin; Commercial Business; Bedroom; Deck;etc.) rn <br /> BUILDING CONTRACTOR: <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 /y <br /> N �J <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 o <br /> T <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m fD <br /> NORTH(N). y 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <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. 9 <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. <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. 'O` C <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN ^ O° <br /> NEEDED. R T \- <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o G`� <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT r <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 /> S TBACK AREA. <br /> 5. <br /> 10 <br /> m Wori00Daf m <br /> 9 N C <br /> Z �, m O <br /> 7. O m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c c <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m d, <br /> CL u <br /> all information contained in this application(including any accomprying schedule)and I further declare that I recognize (D O rn <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 o0 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have a cess to the above deperibed premises at any reasonable time for the purpose of inspection. o <br /> I / (D m <br /> SIGN HERE <br /> (signature of rac (date) <br /> ZONING ADMINISTRATOR / Z� : 69 610 <br /> d)fA(A q N 0 N N N OO <br /> GLh 0 <br /> N (T (TOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />