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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m o 0 <br /> APPLICATION FOR LAND USE PERMITS <br /> N <br /> C <br /> J J N <br /> i TELEPHONE <br /> OWNER UU <br /> m I <br /> O <br /> MAILINGADDRESS O <br /> r <br /> O <br /> PROPERTY ADDRESS (�9//l <br /> LEGAL DESCRIPTION(see tax receipt) O <br /> m <br /> DWELLING/BUILDING ❑ GARAGEIACCESSORY STRUCTURE ❑ ADDITION ❑ (f rn o <br /> TYPE OF PERMIT(S): v } a T <br /> FILLINGI ADING ❑ CAMPING UNIT ❑ SUBDIVISION <br /> STRUCTURE/ADDITION USE: I - <br /> :( e/Cabin; Commercial Business; Bedroom; Deck; etc.) C/) <br /> r ? ?. <br /> BUILDING CONTRACTOR: Q ` m <br /> m r4o <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. 0 <br /> m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 m <br /> n n <br /> T p 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 <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 3o <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. P <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 f <br /> o � t <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN ° Cn, <br /> NEEDED. W <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o 0 <br /> CONDITIONS OF PERMIT: <br /> 1 \ <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. ( ,1 <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 C <br /> SETBACK AREA. <br /> 5. <br /> M C W v 00 1a0m <br /> 6. m 3 m a m A <br /> 7. o � y �, � : _ gym <br /> — »n : ID <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G� c C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of mc, <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize 0 my <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 permi �hiapplic <br /> ther accept all liability w�tich a result of the County of Burnett relying on this information I am d i O <br /> providin n to agree to perm o n officials charged with administering county ordinance or otherauthori d peto ave c s to the abov a cri d premises at any re i e tion. m n <br /> m <br /> DLED <br /> SIGN R <br /> (sig Our of owner r ilding contractor) n (date) <br /> ZONING INISTRATOR JUN 2 Z � <br /> to F»<» <br /> -�69 HI fA Efl� N <br /> � N � NNN � <br /> TOWNSHIP PERMITS MAY BE REQUIRE URNETTCOUNTY 77nnnn��,,nn''�� <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF IS3t�l'C�E'" <br />