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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator -U o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> V o <br /> N <br /> `�) <br /> OWNER �� TELEPHONE <br /> MAILING ADDRESS <br /> Oisy <br /> ' �0 <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) 7-VI Al R i S ltd S tom;S f C> in <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTUREADDITION ❑ <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ �C./�i C2 u a <br /> / �[/ � < <br /> STRUCTURE/ADDITIONUSE: _ A/ ,, GC/ 4/U.c 0 <br /> �J (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) U) <br /> BUILDING CONTRACTOR: <br /> 42 1 <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> O <br /> M N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O \ <br /> � a <br /> TI Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. � <br /> n d A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m I <br /> NORTH(N). <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 <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 �y , <br /> BUILDINGS,ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N p <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE PLANS 0 W <br /> MUST BE SIGNED AND DATED BY THE OWNER. --Z o <br /> Du <br /> 1 F <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN "� o (r� <br /> NEEDED. v 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT a <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 /> SETBACK AREA. <br /> 5. <br /> 6. m 0 0 (D n � m <br /> 3nm xafD <br /> O N C y y 0 3 <br /> 7. Z w m O : -I <br /> O -n`G r11 <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of d n w c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m ; : o my <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 1 am m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to the bove described premises at any reasonable time for the purpose of inspection. T m <br /> O : <br /> CD <br /> SIGN HERE e71- <br /> (signature of own r building contractor) <br /> (date) /V <br /> ZONING ADMINISTRATOR UJ <br /> v N (TNNOO <br /> ,vim/ UON (TO <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 <br />