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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 /> y O <br /> --C t 5- fc,5(a <br /> owNERM C2� 0 TELEPHONE <br /> MAILINGADDRESS <br /> r <br /> PROPERTY ADDRESShnn(IL`tl� <br /> LEGAL DESCRIPTION(see tax receipt) S• 34 T�f' K, �� Eg 9S GO✓ 6 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION C <br /> c <br /> TYPE OF PERMIT(S): or <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITIONUSE: <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: <br /> c <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) OM <br /> T <br /> -n O Z <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 CDC <br /> NORTH(N). CA <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)OFI 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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. I o <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONT ETC.,THE PLANS 0. <br /> MUST BE SIGNED AND DATED BY THE OWNER. ° <br /> J o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICAT N M <br /> NEEDED. 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. JUN „ o <br /> CONDITIONS OF PERMIT: 81jA�i'c� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT C `VfRJ <br /> ISSUANCE. 2O/V� �U/VT' Q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. % ' l n <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY L <br /> PERMITTED. <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER, <br /> SETBACK AREA. �� U-) <br /> 5. �D-d � - � /6. -7L6rte, /, �,)pEiC / �p�f <br /> Z N � oN � n � <br /> 7. <br /> I declare that t thl pplication,4ificluding any accompanying schedule) has been examined by me and to the best of my G) C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of o <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m O mo <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- (D <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 toit county officials charged with administering county ordinances or other ep"Mo <br /> authorized person s t ove scribed premises at any reasonable time for the purpose of inspection. -n ° o <br /> CD m : <br /> d <br /> SIGN HERE �- �_Q �s <br /> n : <br /> (sig ure building contract ) (date) <br /> Cv <br /> ZONING ADMINISTRATOR vi vi <br /> EA M EA 69 8 N <br /> n_ _a••R�rp :b/M O N (T N N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />