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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o� °z <br /> APPLICATION FOR LAND USE PERMITS . <br /> _ r <br /> N <br /> OWNER _5 TELEPHONE ..-��✓" �`fP���0 7 ( ,1 <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS Z% `�j� r Q <br /> E: o` <br /> LEGAL DESCRIPTION(see tax receipt)S' �i��- .-2 y0/6�p'0(�/-3 L A --510 <br /> DWELLING/BUILDING GARAGEIACCESSORY STRUCTURE ® ADDITION <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> �/��- <br /> STRUCTURE/ADDITION USE: 5�2r7C7(� `✓✓ <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) U) <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 E3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a G <br /> T <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m X <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). N a <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO m 3 <br /> CENTERLINE OF ROAD, (C) BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF o- Z <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. t 0 <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. L/ <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. I 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 rI <br /> O ", <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. o <br /> CONDITIONS OF PERMIT: 0 <br /> t <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. nn1.. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY �p O <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> EE W en a �a 0 m <br /> 6. m B a m n m � <br /> omC: o � 3 <br /> c rn COD <br /> o ° <br /> 7. Z o <br /> = m m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of myA <br /> -4 c <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that 1 am responsible for the detail and accuracy of <br /> all information contained in this application (including any accompanying schedule)and I further declare that I recognize (D O <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- `D v <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 ° o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to ave access to the above described premises at any reasonable time for the purpose of inspection. m a <br /> m <br /> SIGN HERE <br /> d S� —DS a <br /> v> a <br /> (si of o er or bu'Iding contractor) (date) r_: <br /> ZONING ADMINISTRATOR vi <br /> G�EflEAEAEA�N <br /> CON Vl W W N O <br /> O V10U (n (JPO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALLXPIR N Y R FRQM D F IS UA N E <br /> (nal leot 0t ��letel� o d�e( ,, <br />