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Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator -0 0 Z <br /> APPLICATIONFOR LAND USE PERMITS 3 <br /> OWNERa <br /> TELEPHONE <br /> v W <br /> MAILINGADDRESS lam' S £O <br /> m <br /> � o <br /> PROPERTYADDRESS e ( ' <br /> LEGAL DESCRIPTION(see tax receipt) V 17 c I Cn <br /> (� m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION Ij o <br /> TYPE OF PERMIT(S): C <br /> FILLING/GRADING CCn <br /> MPI UNIT ❑ SUBDIVISION ❑ <br /> a + <br /> in <br /> STRUCTURE/ADDITION USE: IttalhOl <br /> (Home/Cabin; Commercial Business;Bedro m; Deck; c.) <br /> m <br /> BUILDING CONTRACTOR: wig <br /> m <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEASTAN 8'/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n r. <br /> O rn i <br /> .ZI m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O <br /> -n o <br /> TZ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n 0 A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS (EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). C n <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. 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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BEa`OR:F{LLED. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILCCFOR;rETC., THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE O NER. o <br /> O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS UST BE STAKED SO AN ONSITE AMAY BSD )✓11(iEN., o <br /> NEEDED. <br /> ��(�� ✓, <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. �'hF �QQg o d <br /> CONDITIONS OF PERMIT: 2 C G j <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDT REQUIREMENTS WITHIN 60 DAYS OF PERMM ' <br /> 'Iv�'Vr UN 1 <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIO 14S ARE ALLOWED UNLESS SPECIFICALLY Q <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 6. m m M n m <br /> $ 3 am xn D ;a <br /> C E5 <br /> 7. Z n m o y o� 3 <br /> O T <br /> I declare that this application (including any a companying schedule) has been examined by me and to the best of my �j A <br /> knowledge and belief it is true,correct and con plate. I acknowledge that I am responsible for the detail and accuracy of <br /> PP ( 9 Yaccompanying ) n <br /> all information contained in this application m ludin an schedule and I further declare that I recognize U1 m C o m <br /> that this information I am providing will be relic d upon by the County of Burnett Wisconsin in determining whether to is- <br /> �'. L7 <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 permil county officials charged with administering county ordinances or other <br /> authorized person to have access to the above esc 'bed premises at any reasonable time for the purpose of inspection, m s <br /> -n o : <br /> N m i <br /> SIGN HERE �/�QZ a <br /> (signature of owe r building contractor) (date) <br /> ZONING ADMINISTRATOR 1 <br /> en en <br /> , fA fA EA ffl� N <br /> N N N N O O <br /> (l1 O N (T O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED O <br />