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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator _0 o 0 <br /> APPLICATION FOR LAND USE PERMITS 3r. <br /> N <br /> OWNER TELEPHONE _ p <br /> MAILINGADDRESS //� <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) !r!✓ �r ��t � L�1fiL rte+�� �� i a <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ a o <br /> c <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION�❑ f. <br /> STRUCTURE/ADDITIONUSE: Ll11,� �� n <br /> (Ho a/Cabin; Commercial Business;Bedroom; Deck; c.) ori i <br /> � V <br /> BUILDING CONTRACTOR: <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR .n 3 I 1 , <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O 5 W <br /> A N f� <br /> C �J <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n a <br /> T Q Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE rn o <br /> NORTH(N). 00 <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 S <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO D. <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 C a <br /> MUST BE SIGNED AND DATED BY THE OWNER. n <br /> v � <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. o' <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 /> r f <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 lo' <br /> PERMITTED. O <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> mWrhi (DaOT <br /> W c <br /> 3 n m s n <br /> 6, v y N o 3 <br /> Z N N O 0 <br /> 7. n� m <br /> N <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G) C <br /> �: <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of o 0 <br /> J <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o <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. I further accept all liability which may be a result of the County of Burnett relying on this information 1 am m <br /> providing in this application. I agree to permit county o ficial ring county ordinances or other m o <br /> authorized person to have access to the above described remi for the purpose of inspection. <br /> We=e W =kW <br /> SIGN HERE �+ 3 0 <br /> a : <br /> (signature of owner mg contractor) 2 (date) <br /> ZONING ADMINISTRATOR <br /> / Q MEA <br /> EA fA EA EA N <br /> 61 BURNETT COUNTY N N N O O <br /> TOWNSHIP PERMITS MAY BEMD <br />