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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator vO G Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r o , <br /> CL / CD <br /> TELEPHONE / o M L <br /> OWNER 1 C - �� ( ly C� <br /> MAILING ADDRESS LQ / -J (�) �\� �(� UII C lA �� <br /> PROPERTY ADDRESS / <br /> LEGAL DESCRIPTION(see tax receipt) 1 ✓) J� � 2 <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION ❑ q 0 <br /> TYPE OF PERMIT(S): a <br /> Cr <br /> FILLING/GRADING CAMPING UNIT 11SUBDIVISION ❑ n <br /> �> < <br /> STRUCTURE/ADDITIONOSE: "Gt.�(� caZ o <br /> C j (Hom abin; Commercial B siness;Bedroom; Deck;etc.) Cn l/`) <br /> BUILDING CONTRACTOR: <br /> v <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8Y:X 11 SHEET OF PAPER. ANY INCOMPLETE OR CD3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> M N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p <br /> -n n <br /> n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n 9i A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m M <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m ` f 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF V <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 /> 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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> f <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN � o <br /> NEEDED. 2 2, <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. a <br /> CONDITIONS OF PERMIT: n- <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT w <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 <br /> PERMITTED. Vit <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> iD 3 nm Oa-0. <br /> v mcN� o � 3 <br /> 7. Z m o 1 <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my rr 1' YY' A <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of W d n in c <br /> a a1 : M <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o : m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Is- CD <br /> sue a permit. I 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 o <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection m s <br /> T O : <br /> /.� N N <br /> SIGN HERE <br /> CL : <br /> (signature ofo r or wilding contractor) (h(hate) <br /> ZONING ADMINISTRATOR / <br /> f»ei <br /> EA <br /> 0EAEc) 0 <br /> N U N N N O O <br /> 1y)99 0o� � oo <br /> TOWNSHIP PERMITS MAY BE REQUIRED oC <br />