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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 . <br /> VT o <br /> CD <br /> OWNER TELEPHONE - o <br /> MAILING ADDRESS <br /> 7/ �3 6�4 ° <br /> r <br /> 0 <br /> PROPERTYADDRESS <br /> ao- �a 1 ��-�s <br /> LEGAL DESCRIPTION(see tax receipt) a dos U� Ila ~ Cn <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTU ADDITION ❑ C ti 0 <br /> C <br /> TYPE OF PERMIT(S): cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION <br /> STRUCTURE/ADDITION USE: <br /> 'me/Cabin; ommercial B siness;Bedroom; Deck;etc. <br /> BUILDING CONTRACTOR: 0 <br /> U 42 <br /> 'o <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. O r ,� <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a <br /> ?� b 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 <br /> NORTH(N). fCA 0 <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 Z <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <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 d <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN E <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. .0 1 <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT l <br /> ISSUANCE. I <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. i <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY Q <br /> PERMITTED. tam <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> m m <br /> rOM <br /> M <br /> L C <br /> d c0 <br /> 6. �O. am xA, A <br /> v m c y " 0 3 3 <br /> Z to NO ,p 1 <br /> 7. o - - m <br /> I declare that this application (including an accompanying schedule has been examined b me and to the best of m — ^� A <br /> PP (� 9 Y Y 9 1 Y y � c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of w: Q c N <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m 0 : M <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- C) : <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 m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. ° o <br /> CD <br /> M m : <br /> yr � <br /> SIGN HERE 0 <br /> (signature of ownor buil g contractor) (date) <br /> ZONING ADMINISTRATOR "ff7 = k v> <br /> 6A fR fA di � N <br /> rN(TNNOO <br /> TOWNSHIP P RMITS MAY BE REQUIRED V <br />