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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> N <br /> N <br /> a <br /> OWNER /C TELEPHONE <br /> O--21 <br /> MAILINGADDRESS 7c <br /> �0 m <br /> PROPERTYADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ .. <br /> TYPE OF PERMIT(S): <br /> S n <br /> FILLING/GRADI G ❑ CAMPING UNIT ElaDON C�� � J N <br /> STRUCTUREIADDITIONOSE: / � <br /> X91 <br /> ome/Cabin;Commer ial Business;Bedroom; eck,etc.) m <br /> BUILDING CONTRACTOR: m <br /> v <br /> CID <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/z X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> x m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. A m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). W 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <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. :E a <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. rN <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OIA NER. f I <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS N UST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. e W <br /> CONDITIONS OF PERMIT: I <br /> vl <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTf I REQUIREMENTS WITHIN 60 DAYS OF PERMIT 1 <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIC NS 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 /> 0 1— <br /> > vavD <br /> vm ammn6. 3 F'o C: <br /> 7. Z NCDo <br /> O <br /> M <br /> I declare that this application (including any a companying schedule) has been examined by me and to the best of my la , G2 c C <br /> knowledge and belief it is true,correct and cor iplete. I acknowledge that I am responsible for the detail and accuracy of W. o. 2 <br /> all information contained in this application(in luding any accompanying schedule)and I further declare that I recognize m m o 0 <br /> 01 <br /> that this information I am providing will be reli d upon by the County of Burnett Wisconsin in determining whether to is- C <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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. ° ! o <br /> m m <br /> SIGN HERE 'o <br /> (signature of owner o Ing contractor) (date) <br /> ZONING ADMINISTRATOR <br /> (fl fA fA � N <br /> N T N N O O <br /> (� Ot O (n MOO <br /> TOWNSH P PERMITS MAY BE REQUIRED <br />