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Office of Zoning Administrator M o Z <br /> Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 3 o <br /> APPLICATION FOR LAND USE PERMITS N <br /> G TELEPHONE <br /> -7 II� a <br /> R U1 i� ° Q <br /> MAILI GADDRESS to I1 \ t��� �� �i/ r <br /> 1 <br /> PROPERTYADDRESS <br /> GL a F� /��sv� a - 3 <br /> LEGAL DESCRIPTION(see tax receipt) o <br /> ADDITION cr o <br /> DWELLING/BUILDIN GARAGE/ACCESSORY STRUCTURE a <br /> TYPE OF PERMIT(S): P <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ , HG�, t� T. <br /> r , rn <br /> STRUCTURE/ADDITIONUSE: G v <br /> (Home/Cabin; Commercial Business;Bedroom; eck;etc.) <br /> d <br /> BUILDING CONTRACTOR: <br /> v <br /> m <br /> T 3 <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8Y,X 11 SHEET OF PAPER. ANY INCOMPLETE OR O <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> O m <br /> n <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) v Z <br /> n m � <br /> m <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TI BE SHOWN OR DRAWN TO SCALE. rn n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE to 3 <br /> NORTH(N). m a <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDINGS)TO ALL LOT LINES,(B)BUILDING(S)TO <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF C> c <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <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. 1 N <br /> VIL <br /> o <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILL ETC.,THE PLANS ?. <br /> �� 0 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACT o <br /> MUST BE SIGNED AND DATED BY THE OWNER. q W <br /> ° <br /> BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST <br /> NEEDED. �Z o <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 1 <br /> CONDITIONS OF PERMIT: ti <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF P MIT �UN� n <br /> U <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHO J <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY F�'C J <br /> PERMITTED. 2[��� C�A„ 1 <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIREDWryyJ¢jj, 'V/_y <br /> SETBACK AREA. �(j <br /> 5. 3nmOx <br /> O NC N N O <br /> 6. o ATG <br /> 7. A <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my n c � <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy e o rn <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize <br /> information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> that this i <br /> that <br /> a permit. I further accept all liability which may be a result of the County of Burnett relying on this information I am T o <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 bove described premises, any reasonable time for the purpose of inspection. m . <br /> CD <br /> a : <br /> 40 <br /> SIGN HERE' <br /> (date) <br /> (s g u of ow r building contractor) <br /> ZONING ADMINISTRATOR //�� <n Ln "69 ur 0'N <br /> L" O (N. (NT 00 <br /> / TOWNSHIP PERMITS MAY BE REQUIRED <br />