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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 <br /> r <br /> w O <br /> _ C N <br /> OWNER Q(f Y J to f �Q`t n�19 <br /> TELEPHONE o <br /> _ C <br /> MAILINGADDRESS <br /> _/' (' (� o <br /> PROPERTYAD6RESS p <br /> 3rh ✓0 <br /> LEGAL DESCRIPTION(see tax receipt) 5rr ''L! 90 a R 1S /vow r �y m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE 1:1 ADDITION N to 0 <br /> TYPE OF PERMIT(S): <br /> o- <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: C o'h +vC n <br /> (Home/Cabin; Commercial Business;Bedroom;Deck;etc.) rj) <br /> QVQV <br /> BUILDING CONTRACTOR: m <br /> 12 1� <br /> m <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 /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> C <br /> -n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 3 m \ <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C <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 <br /> BUILDINGS, ROADS, LAKE, LOT LINES. Su <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. O N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC., THE PLANS I <br /> MUST BE SIGNED AND DATED BY THE OWNER. 0 0 <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z ` N <br /> CONDITIONS OF PERMIT: I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT O <br /> ISSUANCE. <br /> I <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. ry <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER 7 <br /> SETBACK AREA. <br /> 5. <br /> X n r D 0 D 0 -0 <br /> N N j n 0 n f m <br /> 6. <br /> 3am �- � fD � <br /> C y fA O <br /> 7. z Nmo <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my _ r^ O <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of m n v. c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize C o m <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 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. fD CD o <br /> CD m <br /> SIGN H ECL <br /> s+ ' a <br /> � <br /> 5 - Z-C/Z <br /> (s nature of r or building contractor) (date) <br /> ZONING ADMINISTRATOR ' <br /> /✓lrl f V Wr fA EA O N <br /> O N <br /> N (N N N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED o <br /> p-d�C-- <br /> �I�' <br />