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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator T o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> m o <br /> N <br /> C <br /> d `l\ <br /> OWNER TELEPHONE / _ o 1 <br /> m <br /> m <br /> MAILINGADDRESS A4 AOJS / 0 <br /> PROPERTYADDRESS <br /> t�-.GGG &;-a o r Sec 357 3 9 N)e <br /> LEGAL DESCRIPTION(see tax receipt) AAT ZI O/ m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ ` (n ° <br /> TYPE OF PERMIT(S): Q <br /> FILLING/G DING ❑ CAMPING UNIT 1�r SUBDIVISION ❑ p , n <br /> I]J < <br /> �j � � s1 y <br /> STRUCTURE/ADDITION USE: ��/YyI /Mei. Q-/7 R-ty> - (its ' 0 <br /> jf (Home/Cabin;Commercial Busine ,Bedroom; Deck;etc.) cn <br /> w <br /> BUILDING CONTRACTOR: u <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. In m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m O 3 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m ID <br /> NORTH(N). y ° <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <br /> ID <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF Z 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 /> S. 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, CONT OR, ETC.,THE PLANS SCJ <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFI TION9 EN ° �r <br /> NEEDED. v <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. A 40# c o <br /> CONDITIONS OF PERMIT: ca AA J C� � <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMI-15�/ N <br /> ISSUANCE. 2p�C' r <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. ` <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. !\t m c0 r- > 0Q0 � <br /> 6. 3 nO yam M <br /> 7. Z w m . ° 1 <br /> o n� M <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my C <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 1 further declare that I recognize m 0 m <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 I amm <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <br /> authorized person to have access to the above described pre es at any reasonable time for the purpose of inspection. ` . s <br /> mo : <br /> m m <br /> SIGN HERE Z/g?J <br /> a : <br /> (signature of o or building ntractor) (date) <br /> ZONING ADMINISTRATOR <br /> (A(A <br /> 4 <br /> 6) N)fA N NCT N N 0 O <br /> TOWNSHIP PERMITS MAY BE REQUIRED f (�j( 0 0 001 0 0 <br />