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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v 0 Z <br /> APPLICATIO FOR LAND USE PERMITS 3 °° <br /> 9,v/ y <br /> r <br /> OWNER -a <br /> J TELEPHONE <br /> m V� <br /> MAILINGADDRESS p) O <br /> I ° <br /> PROPERTY ADDRESS <br /> CLEGAL DESCRIPTION(see tax receipt) <br /> CD <br /> DWELLING/BUILDING ❑ GA AGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ (n o' <br /> TYPE OF PERMIT(S): c <br /> U <br /> FILLING/ AIDING CAMPING UNITdo 7'1 L1N o <br /> STRUCTURE/ADDITION USE: 11 <br /> ' <br /> (Hom /Cabin Comm rcial Business; Bedroom; Deck; etc.) <br /> Cn <br /> BUILDING CONTRACTOR: �. <br /> v <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/z X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. n 3 <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING_ (AERIAL OR TOP VIEW) p <br /> In a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T z <br /> n �b <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m E <br /> NORTH(N). c O <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(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 o 93 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o l� <br /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN qa 0 <br /> J <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z Q <br /> CONDITIONS OF PERMIT: 9 <br /> I ` \ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT (� („� <br /> ISSUANCE. C� <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 AREg <br /> 5. <br /> m c w m a C a * V <br /> 6. <br /> CD <br /> m :) 9 <br /> 7. Z c in ° <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my A <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application (including any accompanying schedule)and I further declare that I recognize m E m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- (���/!� ° cn O <br /> 1: i M 0 <br /> sue a permit. I further accept all liability which ma be a result of the County of Burnett relying on this information I am G : o : <br /> providing i application. 1 agree to perm! b ty officials charged with administering county ordinances or other w <br /> authorize perso to a4 ss to the ab v es ibed premises at any reason r ec 'on. <br /> SIGN HE ° a <br /> F» a <br /> is u ofown r building contractor) (date) Io <br /> ZONING ADMINISTRATOR <br /> JUN 2 2 2005 <br /> O N U W W N O <br /> TOWNSHIP PERMITS MAYBE REQUIREURNETT COUNTY <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSjQVNG <br />