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Burnett County 7410 Co.Rd. K,No.102,Siren,WI 54872 Office of Zoning Administrator _U ci Z <br /> APPLICATION FOR LAND USE PERMITS _. <br /> r <br /> y ° �n <br /> / CD <br /> c <br /> OWNER-�-M Q �e TELEPHONE p . <br /> w <br /> MAILING ADDRESS <br /> CD <br /> PROPERTY ADDRESS 9 0 + H <br /> LEGAL DESCRIPTION(see tax receipt) U)I <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION rn 0 <br /> TYPE OFPERMIT(S): o <br /> t�CT/!I <br /> FILLING/GRADIN El CAMPING UNIT El SUBDIVISION F-1 a <br /> S. <br /> STRUCTURE/ADDITIONUSE: ©\ o� �C� Ta y1 �- Ae Wa- o' <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) to <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81h X 11 SHEET OF PAPER. ANY INCOMPLETE OR T W <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> 71 ai <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p m <br /> m a <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. A 70 <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 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. <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 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> f <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o d <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: Q <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. W p <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. y <br /> 5. ICX jM m r 10 cDi 0 a F m <br /> a <br /> 7. Z m o H <br /> o Tei <br /> =W: m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ^ : O <br /> knowledge and belief it is true, correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m C E rn <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to is- m <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 o <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. m m ,`• c <br /> SIGN HERE <br /> !7ature of owner or (date)it in ntractor) I �: <br /> ZONING ADMINISTRATOR m L <br /> L, I 0 <br /> I lJ ro L" ci c o <br /> e 7� TOWNSHIP PERMITS MAY BE REQUIRED <br /> j1/li THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />