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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> e. <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> toO () j <br /> OWNER /7K TELEPHONE <br /> �A d <br /> MAILINGADDRESS . � /U :Sfi/. u/d�%✓+ �t/Q/ rc_ ����� r <br /> ) / o <br /> PROPERTYADDRESS C / tom' <br /> LEGAL DESCRIPTION(see tax receipt) , "3a C m <br /> 1— pI (� <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION,.& 7'' cn o <br /> TYPE OF PERMIT(S): v <br /> FILLING/GRADING ❑ CAMPING U IT ❑ SUBDIVISIO ❑ <br /> STRUCTURE/ADDITIONOSE: � <br /> ome/C bin;Commercial Busine . edroom; Deck;etc.) to <br /> BUILDING CONTRACTOR: irG <br /> 1 <br /> v <br /> ID <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. p <br /> M N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> In <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m ;? <br /> NORTH(N). 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. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> 0 <br /> CONDITIONS OF PERMIT: <br /> i <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. Vj <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY �1 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> M oOrrDi Ma � � <br /> m <br /> O N C y N O <br /> 7. Z N O t0 <br /> 0 �j Q m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my �j c A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m n vi <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m o : my <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 d <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <br /> authorized person to have access to the above described premise or the purpose of inspection. -n ° o <br /> C <br /> SIGN HERE j J <br /> a <br /> sign ture of owner r building contractor) C r1002 (date) <br /> JU J <br /> ZONING ADMINISTRATOR <br /> O fA EA EA di�N <br /> .I <br /> go ) 000000 <br /> ovvo 0 <br /> TOWNSHIP PERMITS MABf :kp--', O <br /> (`1/ <br />