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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o°A o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> OWNER .�j T'�' L. ! ' TELEPHONE — <br /> C�S <br /> MAILINGADDRESS ^� ,,� �r 0 <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) <br /> m <br /> A <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION <br /> TYPE OF PERMIT(S): a r <br /> Q <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n '� <br /> STRUCTURE/ADDITION USE: 5-/ ee 1 /1 0 9)(Home/Cabin; Commercial B siness; Bedroom; Deck; etc.) m <br /> BUILDING CONTRACTOR: m <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m <br /> DIRECTIONS FOR PLOT PLAN DRAWING- (AERIAL OR TOP VIEW) A'K'u' O m <br /> T n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 m ,ZZj <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS (EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <br /> 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. �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. (J, <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N 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. ,o 0 <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. W <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, 1 <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 /> DODOV <br /> m cmd �+ m o :f m <br /> 6. x3 nm x �" mA <br /> p N C y .`" o = 3 <br /> 7. Z C y O <br /> O <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m N D <br /> PP ( 9 Y ) Y Y <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of d n : u, ; C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize `: oc I I m <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 o <br /> I <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> m <br /> authorized person to have ass to the abov dAscribed premises at any reasonable time for the purpose of inspection. <br /> m <br /> SIGN HERE —�— <br /> nr <br /> a <br /> (s urure of mowr r uilding contractor) (date) 0 <br /> ZONING ADMINISTRATOR �/'t I J an Dian <br /> O �63 fA ER EA�+ N <br /> TOWNSHIP PERMITS MAY BE REQUIRED o N u w w N o <br /> � ocnocn u, rno <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />