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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 3. = 9J <br /> N O V <br /> N (" <br /> n <br /> OWNER TELEPHONE <br /> W C\ I O ll) <br /> ( '/o It' O <br /> MAILINGADDRESS 7j M \ti tC 7`O37 <br /> r � <br /> PROPERTYADDRESS N I (mow 70 o <br /> LEGAL DESCRIPTION(see tax receipt) M <br /> DWELLING/BUILDING <br /> ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ C' In <br /> TYPE OF PERMIT(S): ` <br /> ❑ ° <br /> FILLING/GRADING ❑ CAMPING UNIT ® SUBDIVISIO�'y�n <br /> STRUCTURE/ADDITIONOSE: �[/Y Al�V �J,1�J /W y --z)� 0� <br /> ( ome/Cabin;Commercial Business;Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: <br /> i <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. p <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) M <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). y o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDINGS)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. I P <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 0 t <br /> MUST BE SIGNED AND DATED BY THE OWNER. f (1 , <br /> v � �nCJ <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN g 'I..+ <br /> NEEDED. C5 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: ) <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT w <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 /> CD W� afm <br /> 6. $ 3 n m x n <br /> N C y O j <br /> 7. Z N .0O <br /> O T;2 <br /> M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G q c <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of a 0 - <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o mM <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. I further accept all liability which may be a result of the County of Burnett relying on this information I am N <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. m o <br /> nn ^� m m <br /> SIGN HERE o <br /> (signature of ner or building con or) (date) <br /> ZONING ADMINISTRATORm / <br /> \, 0 11 t� <br /> �EA fA fA ffl�N <br /> N IT N N O O <br /> (TON(T O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 60-71 J <br />