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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 /> fD O <br /> a <br /> ,II// //fJ���j \J �2 O <br /> OVIMER TELEPHONE —�J_71 .� O <br /> MAILING ADDRESS ' <br /> r � <br /> �/ R 0 <br /> PROPERTY ADDRESS \ <br /> LEGAL DESCRIPTION(see tax receipt) m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE El ADDITION ADDITION ' (� � <br /> TYPE OF PERMIT(S): c <br /> FILLING/GRADINGS I❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> STRUCTURE/ADDITIONUSE: b_7 tfLlq_IA mt__ CA-n4 0 <br /> (Home/Cabin; Commercial Business;Bedroom; Deck;etc.) U) <br /> 1j W 91 <br /> BUILDING CONTRACTOR: m <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 61/]X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> M y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> -n Z <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). r_ o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 13 <br /> CENTERLINE OF ROAD,(C)BUILDINGS)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 " 1 <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 I <br /> MUST BE SIGNED AND DATED BY THE OWNER. Q f <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN 0 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z I <br /> CONDITIONS OF PERMIT: o Q <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT W <br /> ISSUANCE. �y <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. V <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY iz <br /> PERMITTED. V\ <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. O <br /> (1) 0 vavM <br /> 6. $ 3 am Fam ;dSe � � 0 <br /> z y � N � � 3 <br /> 7. ° T� m <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of @w <br /> ^ : cn : <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize fin d: C Ino <br /> that this information I am providing will be relied 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 t ' a plication. I agree to permit county officials charged with administering county ordinances or other n <br /> authorized p o o ha access to the above described premises at anlaw"Miffimpurpose of inspection. fDIn <br /> o I <br /> 1111111111m%016111 IF CD <br /> '� l�l� m m <br /> iu <br /> MSIGN � <br /> a : <br /> (sign-at <br /> tuure of ow4r or building contractor) MAY 2 2 2002 mate) <br /> ZONING ADMINISTRATOR V Aanjaan <br /> F»FA En <br /> COUNTY N N N o <br /> � o � o <br /> TOWNSHIP PERMITS MAY BE ING ,� ' <br />