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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 /> N O <br /> V1 <br /> OWNER ` NE p O© <br /> v 0 <br /> MAILINGADDRESS 1 S� (�/ C� (Jl� �✓u�(CJ <br /> PROPERTYADDRESS % qll (�v / I O <br /> cn1 <br /> LEGAL DESCRIPTION(see tax receipt) n` // I N� ( � <br /> ���tttJJJ I fD <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ ° <br /> TYPE OF PERMIT(S): Q <br /> FILLING/GRADING 11CAMPING UNIT 1:1SUBDIVISION <br /> fA <br /> STRUCTURE/ADDITION USE: 0 <br /> l <br /> (Home/ abin;Commercial Business; eddrr 0 <br /> om; Deck;etc.) <br /> BUILDING CONTRACTOR: O ►� LA <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 1 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T T <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> O <br /> o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE AS <br /> NORTH co <br /> 3. SHOW D M)ENSIONS 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 Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. ° <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. rN <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC., THE PLANS ?, o I <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN ° .(= <br /> NEEDED. = U) <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <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. \ <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY It O <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> m , 0i n £ <br /> 6. LD 3 'a m Ox m <br /> a � C:W W 3 <br /> V N O : 7 0 A <br /> 7. O `G x <br /> - m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of W 0 : in <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m O . my <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> sue a permit. 1 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 N <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. o <br /> m M : <br /> � d <br /> SIGN HERE n <br /> (signature of owner 'Iding contractor) (date) <br /> n . <br /> ZONING ADMINISTRATOR <br /> fA fA EA fA � N <br /> N ON N O O <br /> N O (P (P O O <br /> TOWNSHI PERMITS MAY BE REQUIRED <br />