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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v 0Z <br /> APPLICATION FOR LAND USE PERMITS <br /> r <br /> N O <br /> H <br /> CD <br /> G <br /> OWNER TELEPHONE a <br /> 42 <br /> O <br /> v _O <br /> m <br /> MAILING ADDRESS 0 <br /> r CDPROPERTY ADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) — C� --�5 6-(J U C3 l n 0 <br /> � J <br /> C <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ o <br /> TYPE OF PERMIT(S): Q� <br /> FILLING/G,RA/DING ❑ CAMPING UNIT �/❑ 'SUBDIVISION <br /> 40 ❑ 1 n <br /> STRUCTURE/ADDITIONQSE: �L-i n 3 /� -e2o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: <br /> v <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. -n <br /> G� SLo`� �_ap. Gi <br /> 00 N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) b p `m <br /> -n a <br /> n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n �j <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS (EB)AND ALL NEW BUILDINGS(NB)AND INDICATE 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 \v 3 <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF 1 <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. Ll <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, CONTRA T R, ETC., THE PLANS 0 XJ <br /> MUST BE SIGNED AND DATED BY THE OWNER. l 0 1 <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATI � j � XJ <br /> NEEDED. / <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Uv <br /> /� ` n <br /> CONDITIONS OF PERMIT: e ��D <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMITU�NrC� V <br /> CUTTING2. REMOVAL OR <br /> 3. NO GRADING OR SHORELAND A TERATIONS ARE ALLOWED TUNLESS SPECIFICALLY ORLNE. ICN�NG�Nry `W <br /> PERMITTED. O <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> � d = D0aF6. m' m <br /> S axa <br /> D z <br /> D C N N E5. 3 <br /> 7. Z N m O ' <br /> T G M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of m n to <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize CD o m <br /> � <br /> that this information 1 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 d <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m 0 <br /> mo : <br /> CD m <br /> SIGN HER <br /> ( gn ure of n or or contractor) date a <br /> ( ) <br /> ZONING ADMINSTRATOIR <br /> to en <br /> EA Vi fA <br /> N [T N N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />