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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 3e. <br /> r- <br /> N O <br /> 1 f/ U <br /> CD <br /> OWNER TELEPHONE p <br /> MAILING ADDRESS <br /> p m <br /> PROPERTY ADDRESS ! .(.e <br /> LEGAL DESCRIPTION(see tax receipt)/ C� <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ Q rn <br /> TYPE OF PERMIT(S): Q Q <br /> FILLING/GRADING CAG UNIT ❑ SUBDIVIS/N ^� �� <br /> STRUCTURE/ADDfnONUSE: S VV / VX ? <br /> (Ho /Cabin;Comm cial Business;Bedroom,Dec , tc.) c <br /> BUILDING CONTRACTOR: <br /> m <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T o <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m M <br /> NORTH(N). W 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO 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 <br /> BUILDINGS,ROADS,LAKE,LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. ry <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS 1 <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> O 1 <br /> NOTE: BUILDING/STRUCTURE 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: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT �V <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 /> M <br /> 0 r , >O a 0 -0 <br /> m CD M <br /> 6. M 3 cL Ox <br /> M <br /> 7. y M 0 <br /> o . <br /> m <br /> declare that this application (including any accompanying schedule) has been examined by me and to the best of my C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of ' d <n <br /> , n cn ; <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize m 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 do : <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <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 ow uilding contractor) (date) <br /> f <br /> ZONING ADMINISTRATOR <br /> EAd1 ER fA N <br /> � <br /> N N N O O(T 0(T (/� 00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />