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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator -0 L7Z <br /> APPLICATION FOR LAND USE PERMITS 3 ° <br /> - r <br /> In O» <br /> N <br /> C <br /> OWNER �'� ' an f TELEPHONE �5�- �Q[/C` n . <br /> v <br /> MAILING ADDRESS 1D�� `% -� �XL�j //GZC/ Zf O� <br /> r ° <br /> PROPERTYADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) L /% _ (//_ /� .( <br /> 7 <br /> TYPE OF PERMIT(S): <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION El �� o` <br /> ° <br /> FILLING/GRADING CAMPING UNIT ❑ SUBDIVISION <br /> n <br /> �'S% /8 l S'7'- Isg y <br /> STRUCTURE/ADDITIONOSE: 70 o <br /> (Home/Cabin; Com erclaI Business; Bedr om; Deck;etc.) <br /> BUILDING CONTRACTOR: RC1 ? l� <br /> M <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m — <br /> O r <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) O <br /> n C. <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). c 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 v <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. r Z <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO 1 ° <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 ZS <br /> 1, <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> ° dl� <br /> NEEDED. v` <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: ° <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <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 n <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER G( <br /> SETBACK AREA. <br /> 5. <br /> 6. 0 mori0(n * M <br /> 3 R m x a 'D <br /> x <br /> yI0Ng� 3 <br /> 7. <br /> 1 <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 ) m Cv+ c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m 22. o 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 am m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other V o <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> T <br /> <D o <br /> (D fD : <br /> SIGN HERE e» o <br /> n ? <br /> (signature of ne or building contracto (date) <br /> ZONING ADMINISTRATOR �� <br /> N N N N O O <br /> NOUt UtOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED C1 <br />