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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 /> r <br /> N <br /> OWNER TELEPHONE [O/ <br /> 1 0_ <br /> d <br /> �,l y ,/ O <br /> MAILINGADDRESS o� / �0.�GC�Ir 5, �(- <br /> o <br /> PROPERTYADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) parjJn S Z'4 <br /> � m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ c 0 } <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT 11SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: J 742 re-g QJ 0 <br /> (Ho Cabin;Commercial Business;Bedroom; Deck;etc.) (n V gyp' <br /> BUILDING CONTRACTOR: <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. TO <br /> z (D <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> TI n <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C $ <br /> 3. 'SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT,LINES,(B)BUILDING(S)TO m to \ 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF ()1 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, * a <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. l� <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS o Q <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN n o <br /> NEEDED. 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o W <br /> CONDITIONS OF PERMIT: UJ <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. OY\ l W <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 _p <br /> SETBACK AREA. <br /> 5. <br /> 6. m W r0 M0a0m <br /> �D B 2 m 0c �: N p <br /> N C N y p = 3 <br /> 7 Z N ,D O <br /> . 10 <br /> O <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my I�,11( — A <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy ofw v, C <br /> CL c : u M <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize (D O : me <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 <br /> authorized person to have acc o the above described premises at any reasonable time for the purpose of inspection. fD o <br /> SIGN HERE <br /> CIL :: <br /> (signature of <br /> II er or buil Ing contractor) (date) <br /> ZONING ADMINISTRATOR V 1 (n <br /> EA EA EA fA� N <br /> N U• N N O O <br /> N O Vt Cn O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />