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ON COMPUTERISCANNED <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. < <br /> N <br /> OWNER ( Q Y) vN W V o TELEPHONE <br /> W <br /> a� ° <br /> MAILING ADDRESS m m <br /> o „1 <br /> PROPERTYADDRESS c prn e <br /> LEGAL DESCRIPTION(see tax receipt) <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION 0S <br /> TYPE OF PERMIT(S): <br /> a <br /> FILLING/GRADING ❑ CAMPIINk UNNII❑ SUBDIVISION <br /> STRUCTURE/ADDITION USE: �1^J fL� e ° <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) In C <br /> BUILDING CONTRACTOR: <br /> v <br /> m � <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 9 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O - ..� <br /> ;a c C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) -n o. <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m a A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C _. D <br /> NORTH(N). 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO In -° <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OFZ <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. I� ° <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO C <br /> BUILDINGS, ROADS, LAKE, LOT LINES. 'N <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. ry M <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS O <br /> MUST BE SIGNED AND DATED BY THE OWNER. ° <br /> � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o o <br /> NEEDED. <br /> 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o n <br /> CONDITIONS OF PERMIT: <br /> 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. J <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY J <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WA1.LS. ETC.. ALLOWED WITHIN THE REOUIRED WATER <br /> SETBACK AREA. This structure to be used as Private residential <br /> 5. garage/storage only. Not to be used for human A m Or- D ° D o -0 <br /> 6 habitation. m �a a m °% a m A <br /> 'o C <br /> ov, o g3 <br /> Z c R 0 o o <br /> 7. P mn'� <br /> 21m <br /> I declare that this application (including any accompanying scneaule) nas peen exammea oy me ane to me Dest of my G) - : D <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of [ ? n A C <br /> J <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize ( m 0 <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Is- <br /> sue a permit. 1 further accept all liability which may b4a result of the County of Burnett relying on this information I am m <br /> providing In this application. I agree to permit couofficials charged with administering county ordinances or other ,o m <br /> authorized person t e access tot above esc Ad premises at any reasonable time for the purpose of inspection. `° a <br /> T <br /> SIGN HERE . <br /> (signature of owW or building contractor) (date) <br /> ZONING ADMINISTRATOR ` <br /> im <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />