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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator v ci CN-Z <br /> APPLICATION FOR LAND USE PERMITS <br /> r n A <br /> N O <br /> N <br /> , C <br /> OWNER TELEPHONE <br /> MAILING ADDRESS /�� {µ _ �,���^A� � ��% � � p <br /> PROPERTYADDRESS <br /> LEGAL DESCRIPTION see tax receipt) /) _/�/t //` <br /> `TI `t U �f <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ o' <br /> TYPE OF PERMIT(S): � � <br /> FILLING/GRAD CAMPING UNIT ❑ S B ION 1 <br /> STRUCTURE/ADDITION USE: CX <br /> (Home/Cabin�Go mercial Business;Bedroom; Deck;etc.) OT <br /> t\ ' <br /> BUILDING CONTRACTOR: / CD <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 m <br /> -n m <br /> T o- <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE n v <br /> M <br /> ANORTH(N). C 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. Z <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO o <br /> BUILDINGS, ROADS, LAKE,LOT LINES. Q <br /> N <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS 0 O� <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 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z G <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 /> 6. m 0 00AR m <br /> � a � n o <br /> 7. mN N y > > 3 <br /> Z y N O : 0 i <br /> o T� �1 <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my — p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m in C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize C o m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- fD <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 Dp <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> m to <br /> T " <br /> lD 0 O <br /> SIGN HERE m m <br /> ei io <br /> (signature f ow er or building contra or) (date) °- <br /> ZONING ADMINISTRATOR <br /> di di 69 EA�N <br /> NV t N N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 01 0 0 <br />