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Burnett County 7410 Co.Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator 0 0 <br /> APPLICATION FOR LAND USE PERMITSFF <br /> 3. <br /> n i�SrrT\ <br /> N <br /> OWNER dame S TELEPHONE • <br /> pd. I / <br /> 7� o <br /> MAILING ADDRESS '--� I ��.��, <br /> t�C�f 1 if' —r tyu�L 1f V ' 7i 0m <br /> PROPERTYADDRESS � (� <br /> LEGAL DESCRIPTION(see tax receipt) C 0 Cn <br /> J <br /> 2 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING ElGARAGE/ACCESSORY STRUCTURE ADDITION ❑ to ii' <br /> FILLING/GRADI ❑ CAMPING UNIT 0 SUBDIVISION ❑ n <br /> STRUCTURE/ADDITIONUSE: �. <br /> o <br /> ome/Cabin;Commercial Business; Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: � <br /> m 'n <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8Y: LE <br /> X 11 SHEET OF PAPER. ANY INCOMPTE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. OT <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) ;a0 <br /> m <br /> n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 5 ? <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE v <br /> M m <br /> NORTH(N). M <br /> Co <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m Ott'3 <br /> a <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. Z <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO r 9 <br /> BUILDINGS,ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> S. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN0 <br /> NEEDED. w <br /> n <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT it <br /> XJ <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. l <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. d� o(afm <br /> B axacD <br /> � <br /> 7 N C y y 0 = <br /> Z y N O O O <br /> T`G r'tl <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my – A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of C <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- (D' . o <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 d <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m cn <br /> TCD <br /> o : <br /> X � m <br /> SIGN HERE � <br /> (signature of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />