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Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator -CD o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> N 0 <br /> N c <br /> OWNER CA, Q V J TELEPHONE 5 <br /> �o <br /> O <br /> MAILING ADDRESS <br /> 'm <br /> PROPERTYADDRESS t/�f <br /> LEGAL DESCRIPTION(see tax receipt) <br /> m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ 1 N <br /> TYPE OF PERMIT(S): C a <br /> FILLING/GRADING 1-1CAMPINGUNIT El SUBDIVISION <br /> STRUCTURE/ADDITIONOSE / _ /t(/ �` <br /> (Home/Cabin; Commercial siness;BedrooVec etc.) U <br /> BUILDING CONTRACTOR: d <br /> v <br /> CD <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. T O - y� <br /> — <br /> .ZI y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) OT CD <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). y O <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 a <br /> 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. a ` <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o o <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. �- <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. rr <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> d <br /> 6. 3amOx <br /> 'O N C 0 N <br /> R N O O <br /> 7. O T G <br /> M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of myC <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize : m 0 o : rnv <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to isUj <br /> - <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 <br /> providing in this application. I agree to permit county officials charged with administering count ordinances or other �' <br /> P 9 Pp� 9 P tY 9 9 Y <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m o <br /> m m <br /> SIGN HERE o <br /> (signature ofuilding contractor) (date) <br /> ZONING ADMINISTRATOR �4 l U/ � <br /> o r o <br /> Ni <br /> N (cTfA fA o N <br /> NN O O <br /> ^ Cn O (Ji (TOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED rV�-yy <br />