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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 /> N J <br /> N <br /> d . <br /> OWNER PHONE <br /> O <br /> MAILINGADDRESS <br /> r � <br /> o <br /> PROPERTY ADDRESS 1� t <br /> 3`>a � 16 lei <br /> LEGAL DESCRIPTION(see tax receipt) CD <br /> ' <br /> 2 <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ Q-5 rn o <br /> TYPE OF PERMIT(S): a ' <br /> FILLING/GRADING ❑ CAMPING UNIJ/� SUBDIVISION ❑ o. <br /> / N <br /> STRUCTURE/ADDITIONOSE: �.Q�YI�iiJ � �1B ° <br /> (Home/Cabin;Commercial Business; droom;Deck;etc.) <br /> BUILDING CONTRACTOR: iu v <br /> v <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. r <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. (� A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). y o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <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 BE GRADED OR FILLED. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS 0 OQ <br /> MUST BE SIGNED AND DATED BY THE OWNER. o w <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z "\) <br /> CONDITIONS OF PERMIT: o <br /> r <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT I <br /> ISSUANCE. v <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY LO <br /> PERMITTED. <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> CD Dnim0M0m <br /> 6. 3 'a(°D Zai <br /> ((DD C y m O j 3 <br /> 7. Z N C-. O : � -{ <br /> O T� <br /> M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my r <br /> c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of �` <br /> XJ : CL v, : <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m C : O : Ino <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 1 am d <br /> P P H Y tY Y� 9 W <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described P.Lemises at any reason le time for the purpose of inspection. (D <br /> T O <br /> N <br /> SIGN HERE J 7 Q D� <br /> n : <br /> (signature ow er or buil i contra ) (date) � ) <br /> ( 'v <br /> ZONING ADMINISTRATOR <br /> to(A(A fA�+N <br /> N C" N N O O <br /> (TOU(TOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />