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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Admini5trator n o 0 <br /> APPLICATION FOR LAND USE PERMITS <br /> �/ or (N <br /> OWNER TELEPHONE (j f <br /> MAILINGADDRESS <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION(see lax receipt) 1 rn `^ <br /> DW ELLINGIBUILDING ❑ GARAGEIACCESSORY STRUCTURE 1-1ADDITIONtJ�l m <br /> 2, <br /> TYPE OF PERMIT(G): <br /> FILLING/GRADING ❑ CAMPING UNIT El SUBDIVISION ❑ - <br /> STRUCTURE/ADDITION USE: " O d� '-4— n <br /> (HomelCabin, Commercial Business: Bedroom; Deck; etc.) r <br /> BUILDING CONTRACTOR: <br /> v � 7 <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. O <br /> Pa m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> T <br /> O <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. TO o v <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE an <br /> NORTH(N). v O <br /> g. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO fmrl 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF v <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 <br /> BUILDINGS, ROADS,LAKE,LOT LINES. I <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. �Q 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. 0 1 <br /> O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o Y <br /> CONDITIONS OF PERMIT: �. <br /> O <br /> i. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT I/ll <br /> ISSUANCE. 1 <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 /> D <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC„ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> X mt7r DOD09 <br /> 6 c m aFM <br /> O c m 0 H <br /> ]. <br /> v< m <br /> I declare that this application(including any accompanying schedule) has been examined by me and to the best of my 6 w j O <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of ! m •`+ u <br /> all information contained In this application(including any accompanying schedule)and I further declare that 1 recognize [ i $ m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is. p _ 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 o <br /> providing In this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized parson to have access to the above described premises at any reasonable time for the purpose of inspection. TI <br /> J �� �� D; <br /> SIGN HERE L � O � w <br /> (5!Tu of owner or bu Idab,contactor) ' ' ( (� <br /> ZONING ADMINISTRATOR ( O <br /> Oo ouo <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> T S PERMIT SHALL EXPIRE ONE YEAR FROM DATEISSUANCE <br /> mIJ- i (e,+ t� pieLtc1 - - ��I �l(olnL- /soh q- a0- Ob <br />