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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> � 0 <br /> N <br /> C <br /> m <br /> OWNER TELEPHONE <br /> MAILINGADDRESS O <br /> a �^ <br /> PROPERTYADDRESS � <br /> LEGAL DESCRIPTION(see tax receipt) slo <br /> 7 c <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ (A O �. <br /> TYPE OF PERMIT(S): Q <br /> FILL <br /> ING/G DIN CAMPING UNIT ❑ SUBDIVISION Ll � � n <br /> STRUCTURE/ADDITION USE: ° Q <br /> T (Home/Cabin; C mercial Business; Bedroom; Deck; etc.) C/) <br /> v <br /> BUILDING CONTRACTOR: <br /> v <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 r ` <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O " W <br /> M y ' <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> m <br /> M Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). N o <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 Z <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. O` <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N 1 <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 OWNER. f W <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. o <br /> CONDITIONS OF PERMIT: (�i <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT N <br /> ISSUANCE. O <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 AREA. <br /> 5. <br /> M CWW00 om <br /> 6. m XD am Fnm <br /> -o o0C: no` s <br /> N <br /> 7. <br /> Z c o -f <br /> A <br /> _ (, i m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m A <br /> PP ( 9 Y ) Y Y G) 4 C <br /> knowledge and belief it is true, correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of v �_ <br /> all information contained in this application (including any accompanying schedule)and I further declare that I recognize } CD <br /> C 0 <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- qt <br /> u <br /> sue a permit. 1 further accept all liability which may be a result of the County of Burnett relying on this information I am a' : o <br /> is <br /> providing i is application. I agree to permit c officials charged with administering county ordinances or other m <br /> authorize per n to ha ss to the�bbove d ri ed premises at any reasonable time f the ur ose of ins on. ° a <br /> T <br /> D : <br /> SIGN H E 1 n <br /> (s' n ure of building contractor) (date) 0 <br /> ZONING ADMINISTRATOR <br /> w vi va <br /> O N C T W W N O <br /> O V10N Vl CnO <br /> TOWNSHIP PERMITS MAY BE REQUIRED BURNETT COUNTY <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUING <br />