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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> �} APPLICATIO FOR LAND USE PERMITS 3 <br /> CD <br /> 5t4J <br /> OWNER TELEPHONE <br /> O <br /> MAILING ADDRESS <br /> 0 <br /> o <br /> PROPERTYADDRESS Zorn Q� <br /> LEGAL DESCRIPTION(see tax receipt) <br /> t !` m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ �� ° 4-^ <br /> TYPE OF PERMIT(S): L` o <br /> FILLING/ DING 1:1CA P UNIT ❑ BDIVI SUON ❑ / > �' \ Q J <br /> ly, N <br /> STRUCTURE/ADDITION USE: _ r1'� nw /6 /` ° <br /> (Ho /Cabin; Comm ial Business; edrocm; Deck; etc.) to <br /> BUILDING CONTRACTOR: /// /_ <br /> v <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/z X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 . <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p — <br /> ;0 U <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. a m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <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 \ <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 BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. f <br /> D (. - <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN 0 � <br /> NEEDED. \ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z C <br /> 0 <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. \ Q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. �} <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY (� Q <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER w <br /> SETBACK AREA. <br /> 5. <br /> X U]0 > 0 > 0 <br /> 6. m F3 am yam <br /> O0 (U C y N O j 3 <br /> 7. Z C m m O D� <br /> O N : Tl� <br /> — C') : m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m A <br /> PP ( 9 Y ) Y Y C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of n v <br /> all information contained in this application (including any accompanying schedule)and I further declare that I recognize �: m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- D Cn - t7 <br /> sue a permit. I further accept all liability which may be a result of the County of B rrlett_re f m m o <br /> providin s application. I agree to permit my officials charged with ai� c r <br /> authori d pers n to aZ c ss to the ab ribed premises at any reason is r s f' i <br /> T O <br /> SIGN H R <br /> (si ature f owner or 'I g contract ) AN Z(d o <br /> ZONING ADMINISTRATOR <br /> BURNETT COUNTY <br /> dv va/n <br /> TOWNSHIP PERMITS MAYBE REQUIRED <br /> ZONING <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />