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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 /> V o <br /> N <br /> ` _ C <br /> OWNER / ,c/arc[ l-e nl z eTELEPHONE �S-��G - /� <br /> / n <br /> MAILINGADDRESS <br /> m <br /> 0 <br /> PROPERTYADDRESSr ` <br /> LEGAL DESCRIPTION(see tax receipt) N K 4 P) —//6 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTUREX ADDITION ❑ '(� ) to ° <br /> TYPE OF PERMIT(S): <br /> FILLING/G DING ❑ CAMPING UNIT 1:1 SUBDIVISION ❑ �( 5. <br /> STRUCTURE/ADDITIONUSE: -GL ZL�QC�.LJ / o <br /> (Home/Cabin;Commercial Business ed room; Deck;etc.) <n <br /> n � ) m <br /> BUILDING CONTRACTOR: P�S r6 1 <br /> 0 <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 m � <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). y 1 0 <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 �o <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. .0 <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <br /> ,41z� <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 o <br /> v � <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN ° <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 / <br /> ISSUANCE. <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 WATERCV <br /> SETBACK AREA. <br /> _ <br /> m m� C a f m <br /> Z H m —1 <br /> CD <br /> 7. oo T� <br /> M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ID <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m o iA <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o m <br /> that this information 1 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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <br /> authorized perso o hav'b ac s he above d cribed premises at any reasonable time for the purpose of inspection. m o <br /> CD <br /> CD <br /> SIGN HERE <br /> n : <br /> (signature ofor building contractor (date) <br /> ZONING ADMINISTRATOR I&Iajoo� <br /> dl EA EA H N <br /> N (TNN O O <br /> N (T (T O O <br /> TOWNS IP PERMITS MAY BE REQUIRED O <br />