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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. rCl� <br /> N O \_ <br /> N <br /> /� <br /> C <br /> OWNER d h r, k o V D 4jTELEPHONE 6 3S 3 01J n a <br /> R �Q <br /> / / J ( u p q D O <br /> MAILING ADDRESS <br /> o?76 5 �/ f r <br /> r �\� <br /> PROPERTY ADDRESS Pot/ <br /> LEGAL DESCRIPTION(see tax receipt) S L eC r�/V V �y M <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE 11ADDITIO rn <br /> c <br /> TYPE OF PERMIT(S): <br /> Q <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ S. <br /> • L y <br /> STRUCTURE/ADDITION USE: <br /> (Home/Ca ' ; Commercial Business; Bedroom; Deck; etc.) <br /> 2 <br /> BUILDING CONTRACTOR: 9 <br /> m <br /> 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 — <br /> � " C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> T <br /> ,n O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m O <br /> NORTH(N). \ Zl <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO m r <br /> CENTERLINE `\ <br /> OF ROAD,(C)BUILDING(S) MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. P <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO O <br /> BUILDINGS, ROADS, LAKE, LOT LINES. SU <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 ° OQ <br /> MUST BE SIGNED AND DATED BY THE OWNER. 1 <br /> O 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: o ` <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ry <br /> ISSUANCE. J <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Ot, <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> G <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> CD W m m o � n m <br /> LD_ x3 'am am <br /> 6. o o N co, i �� 3 <br /> Z w m <br /> 7. o m Tom : m <br /> =- cn fl O <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G) c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of g n <br /> all information contained in this application (including any accompanying schedule)and I further declare that I recognize mCD <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- s <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 O <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized perso have access to the above de cribed prem' es at any reason -n <br /> a : <br /> CD a : <br /> SIGN HERE <br /> (si a re of ow r building contractor) (date) <br /> ZONING ADMINISTRATOR c 1 2005 <br /> va v+u> <br /> G o N 0 rn W N O <br /> TOWNSHIP PERMITS MAY BE REQUIREd3URNETT COUNTY C� `� <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISS G <br /> Mai Le / <br /> i` � ((�XJJnn <br />