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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -a 0 Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> 0 qJ <br /> OWNER TELEPHONE 7/�, ,yQ -;B'7 n <br /> MAILING ADDRESS O <br /> PROPERTYADDRESS <br /> r m <br /> LEGAL DESCRIPTION(see tax receipt) <br /> 1� 1 R <br /> DWELLING/BUILDING Q <br /> TYPE OF PERMIT(S): GARAGE/ACCESSORY STRUCTURE ADDITION ❑ o <br /> c � <br /> FILLING/GRADING CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: <br /> o' <br /> (Home/ in; U00mercial siness; Bedroom; Deck;etc.) � <br /> d /AK s 'l <br /> BUILDING CONTRACTOR: W ^' <br /> d <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. In 3 <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) ACD <br /> y T� <br /> c O. <br /> M <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. In a <br /> In l t ? <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE 0 o JV ;10NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF - <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. Z <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(OF),AND ALL DISTANCES TO o <br /> BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. SCJ <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> a <br /> �[ � 0 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFIC' tE� <br /> _ oNEEDED.THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: e �qN5 �a3 0 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMITNF77 <br /> ISSUANCE. L`O <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE?O/V UN� <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. 1 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 6. dgoni0m <br /> 3 CL(D M <br /> 7. N C 0 O j' Z <br /> Z R N O 10 <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my o m� p <br /> = cn m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of a c N C <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize �O m E o : m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- OG <br /> m : v <br /> sue a permit. I further act !lily whit result of the County of Burnett relying on this information I am Dc G <br /> providing in this app <br /> li on. I afire to pe it county o ials charged with administering county ordinances or other <br /> authorized person to ave acce ea o e described emises at any reasonable time for the purpose of inspection. to <br /> m <br /> . <br /> T 0 <br /> o : <br /> SIGN HERE / _ JJ _ Oh 7 'D i3 . <br /> (s n e o 0 or building contractor) (date) <br /> ZONING ADMINISTRATOR (� <br /> TOWNSHIP PERMITS MAY BE REQUIREDl� <br />