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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATIO14 FOR LAND USE PERMITS 3. <br /> O <br /> c <br /> J <br /> OWNER �/ TELEPHONE --C;*09 0 <br /> �5MAILING ADDRESS ADDRESS f <br /> r � <br /> PROPERTY ADDRESS 3/JS ° <br /> fc) <br /> LEGAL DESCRIPTION(see tax receipt) Cn <br /> m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION cn ° <br /> TYPE OF PERMIT(S): (� Q <br /> FILLING/GRADING ❑ C WPING UNIT ❑ SUBDIVISION ❑ 17✓ /� <br /> STRUCTURE/ADDITION USE: 1q4d 0 <br /> ( ome C us <br /> bin;Commercial B ' ess; Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: !� d <br /> v <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LE ST AN 81/]X 11 SHEET OF PAPER. ANY INCOMPLETE OR n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. Y t <br /> 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AE RIAL OR TOP VIEW) Om M <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. f7 m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m � <br /> NORTH(N). 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 \ Z <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. ° <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 B AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. F <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. II �– <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o ` <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 <br /> PERMITTED. A1J <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> J/-g <�'�/`-C •— � 3 a m 'r � n_ A <br /> y <br /> 0 N N O : t: <br /> U O -n <br /> M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G) A <br /> knowledge and belief it is true,correct and co plete. I acknowledge that I am responsible for the detail and accuracy of W <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize J m o <br /> CD <br /> that this information I am providing will be rel ed 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 ad <br /> providing in this application. I agree to perrr it county officials charged with administering county ordinances or other <br /> authorized person to ve access the abovedescribed premises at any reasonable time for the purpose of inspection. o <br /> m <br /> SIGN HERE <br /> i r or building contr ,^ (date) <br /> ZONING ADMINISTRATOR IaNAI <br /> v <br /> r V 92 //�• / • r fA fA fA 0 N <br /> (TNNOO <br /> (� (TOCT (n00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED ��?9a &t J <br />