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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 c) Z <br /> APPLICATION FOR LAND USE PERMITS _. <br /> r <br /> CC <br /> Ork <br /> TELEPHONEOWNER ' � 70 <br /> MAILING ADDRESS <br /> CD <br /> (� r1 m <br /> PROPERTY ADDRESS0,4t'— <br /> LEGAL <br /> K} {ti <br /> IRA <br /> LEGAL DESCRIPTION(see tax receipt) 3�O �/�/�7 I�-'j -t3az� �� S� /,, j �rJ i/,� /� C <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION Yf lJ" U) o' ray <br /> TYPE OF PERMIT(S): C <br /> cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> y 1� � <br /> STRUCTURE/ADDITIONQSE: a U I, A,- z �CG d't/1 �j�/� c�V o <br /> (Home/C In;Commercial Business;Bedroom; Deck;etc.) Cn \ <br /> v <br /> BUILDING CONTRACTOR: <br /> p <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/a X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O (D \ <br /> n a <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n Cv Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO CO) 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF \ v <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. Q , v 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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> n O <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: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT � ) <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. N <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY A i <br /> PERMITTED. l' <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 6. m d 0,0 n F m <br /> 8 3 nm Fnm A <br /> Z N CO <br /> 7. D <br /> T G M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G1 C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of o n Fn <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m ; o m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> v <br /> t7 <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information I amm <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other rLu <br /> authorized person to have access to the above desribed premises at any reasonable time for the purpose of inspection. m <br /> CD p : <br /> SIGN HERE <br /> (signature of wner or building contractor) (date) n <br /> ZONING ADMINISTRATOR )!►1 <br /> ^y fA <br /> (6i fA fA�N <br /> NTNNOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED �� ` u o u <br /> 1" Lam-; <br />