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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 . <br /> VT O <br /> OWNER TELEPHONE n <br /> v O <br /> d <br /> m <br /> O <br /> MAILING ADDRESS A�e - <br /> � 7 r <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) — ' m <br /> \ 2 <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTU E ADDITION ❑ �. cn ° <br /> TYPE OF PERMIT(S): v <br /> FILLING/GRADING CAMPING UNIT ❑ Z U IVISION <br /> STRUCTURE/ADDITIONUSE: _ ✓ � �N �� 0 <br /> I Z'021`22Z� <br /> mercialgqB��sine�ss;Bed om;Deck;etc.) dBUILDING CONTRACTOR: ( LJ CaG/ <br /> d <br /> T <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN fiY:X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. A 0 � <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). y o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF R <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN ° <br /> NEEDED. 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <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 WATER <br /> SETBACK AREA. <br /> 5. <br /> X m r 0 � n4E M <br /> 0 <br /> 6. $ 3 o m Fam ;a <br /> O ry C y y 0 = 3 <br /> 7. Z N N O :O 10 <br /> o n m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my �j A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of a <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize m O my <br /> that this information I 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 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 o <br /> M m <br /> SIGN HERE <br /> n : <br /> (signature of owner or ulldin c ntractor) �h (date) <br /> ZONING ADMINISTRATOR <br /> EA fA fA fA N <br /> 0 N N 0 00 <br /> Ln <br /> UI 0010100 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />