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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 3. <br /> N <br /> C <br /> N <br /> OWNERA"&17L )etc ���S TELEPHONEo <br /> „ �+ 4 O <br /> MAILINGADDRESS <br /> r <br /> 0 <br /> PROPERTY ADDRESS b�^. <br /> L <br /> LEGAL DESCRIPTION(see tax receipt) �-�- v a(06 N �^ <br /> m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ o <br /> TYPE OF PERMIT(S): n <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> I f m <br /> STRUCTURE/ADDITION USE: No 0 X ^ <br /> (Home/Cabin; ComQnercial Business; Bedroom; Deck; etc.) m <br /> m <br /> BUILDING CONTRACTOR: m <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/:X 11 SI EET OF PAPER. ANY INCOMPLETE OR T 3 , <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> x H <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> T <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m ,Zv <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDIINGS (EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). to v 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUDING(S)TO ALL LOT LINES, (B) BUILDING(S) O m <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 91 <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. f <br /> o D <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: ,1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT �J <br /> ISSUANCE. I <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RaSTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWOD UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 6. m x 3 a m x a m A <br /> 7. p m T'< <br /> — N : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my d' O <br /> c � ; C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m n u, : ;0 <br /> all information contained in this application(including any accc*npanying schedule)and I further declare that I recognize [ M c _ mm <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> L7 : <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information 0 <br /> on I am d o <br /> providing in this application. I agree to permit county officials charged with adm' i alf-ot er j <br /> authorized person to have access to the above described premises at any reason i e f r th r I T a <br /> tj 11 _ M D k <br /> SIGN HERE LP.�./ C 4_APA <br /> (signature of ow or building contra tort r1 "fdit7 U 0 <br /> ZONING ADMINISTRATOR ISS G LW <br /> OmI�Jp BURNET f COUNTY <br /> `o—kc. TOWNSHIP PERMITS MAY BE REQUIRED ZONING o o o <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />