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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 'D o o <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> N <br /> CD <br /> U) <br /> C <br /> OWNER /II�Oh. A TELEPHONE J I4 q`" S`q3 O o _ t <br /> MAILING ADDRESSjQ(� S+C� 4L„y�J f�® �t-tDSfk L�-L• 51{ 3 �� <br /> PROPERTYADDRESS(AC) <br /> W)I ed F gw b La-1- rl83 o ( <br /> LEGAL DESCRIPTION see tax receipt) S S S <br /> DWELLING/BUILDING IKGARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ <br /> � o fn <br /> TYPE OF PERMIT(S): _ \jam <br /> ^pO FILL / RADING ❑ CAMPING UNIT ❑ SUBDIVISION El < W <br /> STRUCTURE/ADDITION USE, b W J2� ����(a �q� 0 (� <br /> (Home/Cabin;Commercial Business;Bedroo eck;etc.) <br /> BUILDING CONTRACTOR: Q <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> ja N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a <br /> T 2 <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 C <br /> NORTH(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 <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. ° <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. IN <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE PLANS 2 --1 � <br /> MUST BE SIGNED AND DATED BY THE OWNER. (�� f <br /> q <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a 0 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <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 AW. <br /> 5. <br /> 1117777���� m 0o0= <br /> 6. �. 3 a m x ;n <br /> -O ry C <br /> Z RN0 <br /> 7. o n� <br /> - m : . rn <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G) c c <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of n ^ : 16 <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize (D o 0 <br /> that this information I 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 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 acSVs to the above d ribed premises at any reasonable time for the purpose of inspection. m ° o <br /> CD <br /> SIGN HERE 'n <br /> (signature of o er orb ilding contractor) � (date) <br /> i <br /> ZONING ADMINISTRATOR <A eA <br /> EA di<A EA— N <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />