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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator CD o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> (n O <br /> f/1 <br /> d <br /> OWNER TELEPHONE 71 — 73 7to o <br /> CD O yu <br /> (2 f /) <br /> MAILINGADDRESS �CJ / ��� £ <br /> CD <br /> S 30 <br /> PROPERTY ADDRESS Q ' <br /> d� <br /> LEGAL DESCRIPTION(see tax receipt) (ct Id s t 6 5 E 5 E Ex I/ 3b3P? � ID <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ cn <br /> TYPE OF PERMIT(S): Q -, <br /> /� n <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ p(N a�J� •I <br /> STRUCTURE/ADDITION USE: !V GU EDO <br /> (Home/Cabin;Commbrcial B ness;Bedroom; De k;etc.) c <br /> BUILDING CONTRACTOR: 2 <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR T <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> M o Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE yo <br /> NORTH(N). 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. W ° <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 �_ <br /> MUST BE SIGNED AND DATED BY THE OWNER. ° <br /> 21 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN -% ° <br /> NEEDED. (lS a <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: Q i <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. v <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 /> m m r 0 M 0 . m <br /> d <br /> 3 <br /> 6. N N O N ?1E <br /> 7. O nm <br /> - cn : <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G)c A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of CL c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize /� 0 0 <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. 1 further accept all liability which may be a result of the County of Burnett relying on this information I am of <br /> providing in this application. I agree to permit county officials char t ounty ordinances or other <br /> m <br /> authorized person to have access to the above described premises at he purpose of inspection. -n o <br /> CD m : <br /> SIGN HERE <br /> (si a re of owne r building contractor) Jl; 2U0 (date) )✓: IN <br /> ZONING ADMINISTRAT R c <br /> L?Ur1iVE1 1 COUNTY � cNn o cNicNn o <br /> TOWNSHIP PERMITS MAY BE REQWBW1G <br />