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Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator ' ° o <br /> APPLICAJI01%%FOR LAND USE PERMITS 3 <br /> G-4n vL <br /> a <br /> //�� TELEPHQNE 9 <br /> OWNER Q0V <br /> O <br /> MAILING ADDRESS <br /> r � <br /> PROPERTYADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) — —/ j /V6 U AL L a c Q <br /> m <br /> 2 <br /> DWELLING/BUILDING ElGARAGE/ACCESSORY STRUCTU E ElADDITI ❑ ° <br /> c <br /> TYPE OF PERMIT(S): CL <br /> Q <br /> PILLING/GRADING ❑ CAMPING UNI SUBDIVISION T <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Comr9ercial Business;Bedroe�m; Deck;etc.) <br /> U,1 X) <br /> BUILDING CONTRACTOR: Z < <br /> m dl <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. n /� 0 N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) r�7 AUX (�Wl &�Lt <br /> 6 -n 1Da <br /> T v z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m ; <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AN o <br /> NORTH(N). m <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO <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. c <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 2, --i f\e, <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> o 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN = ° CJ <br /> NEEDED. �1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z Il <br /> o <br /> CONDITIONS OF PERMIT: Q <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 /> (D W N 0 N a m <br /> 2 3 o. ( Fa`" M <br /> 7. ° m <br /> _ �n A <br /> I declare that this application(including any accompanying schedule) has been examined by me and to the best of my G) , <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of r, , a <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize X/ M M o rn� <br /> that this information 1 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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <br /> M N: <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m : o <br /> M <br /> m : <br /> m : <br /> C : <br /> SIGN HERE ° <br /> (signature of owne wilding contractor), (date) <br /> ZONING ADMINISTRATOR �Z1 <br /> N (T N N OO <br /> n O 0 N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />