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Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator vci Z <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> 0 <br /> rn ,/ c o <br /> OWNER D0 A/ /yQ 1-L� (V TELEPHONE 3 Q"1c,e7.(q- 7 S cj I 0 ly <br /> MAILING ADDRESS PC B e rJ, [,r a 4s 6 u r q. WT 5"+%4 o <br /> m <br /> PROPERTY ADDRESS <br /> d <br /> LEGAL DESCRIPTION(see tax receipt) �U-f / C S/y\ l q3S �� (`t <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ CU c 0 <br /> TYPE OF PERMIT(S): Cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION <br /> ❑ <br /> STRUCTURE/ADDfrIONOSE: o <br /> (Ho a/Cabin;Commercial Business; Bedroom; Deck;etc.) rn <br /> BUILDING CONTRACTOR: <br /> N '1l <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR � W <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> 0 N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> -n a _ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n 0 �p <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 /> n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO CO) 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. 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. :E <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, CONTRACTOR, ETC.,THE PLANS X,l <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> 4 <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN S `(�\ <br /> NEEDED. <br /> ems+ <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. 1 L Q <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY 5j <br /> PERMITTED. (!D` <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> m 2) 0 M CL � M6. 2 3amOx m � <br /> O N C y N = 3 <br /> 7. z y m c ' <br /> declare that this application (including any accompanying schedule) has been examined by me and to the best of my cj 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 : v, <br /> C, v <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize m 0 : rnt7 <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 o <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. 'D o <br /> SIGN HERE,` T�l!'-'"� 'Y �� Z0"0.5 _ <br /> (s nat a of o er r building contractor) (date) a <br /> ZONING ADMINISTRATOR <br /> 01 <br /> N (r NO O <br /> N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />