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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 o <br /> 1lQKes TELEPHONE <br /> rfJ J O7 <br /> MAILINGADDRESS 31 '71-b- �'�'r?�d�cc ��r ,aGz q.IC�J (�f SSSS 5� o O <br /> PROPERTYADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) W S <br /> DWELLING/BUILDING X GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ (n o <br /> TYPE OF PERMIT(S): Q <br /> FILLING/GRADING ❑ CAMPING/UNIT ❑ SUBDIVISION ❑ n y`�-' <br /> 0 <br /> STRUCTURE/ADDITION USE: I s �\ <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) j <br /> BUILDING CONTRACTOR: P _ E, <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. T ry� <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O re o <br /> T 0 Z <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). (a 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 Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. \ P <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. 1 lz�l <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. Cr N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS ° Q <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN ° w <br /> NEEDED. r <br /> 1 <br /> C? <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o p <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT A C� <br /> ISSUANCE. � G <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 /> X W O r- D O D 0 -0 <br /> m cm0mo. F m <br /> 6. m ,'c3 am � L05 <br /> ' cD <br /> -o omcN `^ <br /> 7. Z c m (D <br /> o <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m ^ ' d : O <br /> PP ( 9 Y ) Y Y 0— � ; C <br /> ' <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m <br /> all information contained in this application (including any accompanying schedule)and I further declare that I recognize m ! rn <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. I further accept all liability which may be a result of the County of Burnett relying on this information I am d O <br /> providing in this application. I agree to permit county officials charged with admen' t r ces or other iff <br /> authorized person to have access to the above described premises at any reasona i It ° o <br /> IL <br /> ❑� a : <br /> SIGN HERE <br /> ( ' n ure of o er or building contractor) JUdate) 0 <br /> ZONING ADMINISTRATOR ML I <br /> fA EA� N <br /> BURNETT ggMM <br /> TOWNSHIP <br /> ITS MAY BE REQUIRED ZONING ZUiViNG <br /> TH PERMIT SHALL EPIRE�ON�Ei YEAR FRQM DATE OF SUANCE <br />