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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v Z <br /> APPLICATION FOR LAND USE PERMITS <br /> 0 <br /> y, O <br /> N <br /> 7 � <br /> OWNER ec" t t)')-k ��L TELEPHONE o <br /> d <br /> MAILING ADDRESS <br /> m <br /> PROPERTY ADDRESS ] <br /> rr ( X4 <br /> LEGAL DESCRIPTION(see tax receipt) �J/n � I � .� I (�� 18� <br /> C 1 n <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ o <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING CAMPING UNIT 11SUBDIVISION <br /> rr <br /> STRUCTURE/ADDITION USE:�^& 1 l�/C e. �S ly1N o <br /> (Home/Cabi ;Commercial Business;B dr ; Deck;etc.) rn <br /> W <br /> BUILDING CONTRACTOR: �Q�, �/) '' <br /> v <br /> m <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 /> Xl N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> n a <br /> T � Z <br /> 7. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n DK5 �u <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE 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 m 3 <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. 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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. `^ <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS ro <br /> MUST BE SIGNED AND DATED BY THE OWNER. y\\ <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: V <br /> 1 <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. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 6. m y% 0 O a 0 M <br /> m <br /> 3 o. MO 0,: M ;d <br /> (gyp N N N ? = 3 <br /> 7. Z y N o <br /> O n G M <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m 0 v� <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m <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. m C <br /> oCD : <br /> M m <br /> SIGN HERE d' <br /> (signature of owner or building contractor) (date) a <br /> ZONING ADMINISTRATOR <br /> fA fR EA EA � N <br /> N (T N N O O <br /> (T O (T (T O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />