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Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS �. <br /> r <br /> y O <br /> N <br /> C <br /> OWNERDTELEPHONE �� k1SGU o <br /> m T_ <br /> MAILINGADDRESS WT <br /> F \ <br /> M v <br /> r M <br /> O_ <br /> PROPERTY ADDRESS p <br /> LEGAL DESCRIPTION(see tax receipt) L rn <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTUR ❑ ADDITION ❑ CO o <br /> TYPE OF PERMIT(S): C <br /> FILLING/ RADING ❑ CAMPING UNIT ❑ SUBDIVISION <br /> U <br /> STRUCTURE/ADDITIONUSE: Jac) rQr <br /> c <br /> bin; Commer Ial Bu�ss;Boom; Decketc.) rn <br /> I/ <br /> W <br /> BUILDING CONTRACTOR: 4293-c;" 0 `W <br /> ' <br /> v <br /> m <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. m <br /> M m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> n cL <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n d 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). y o <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 Z t <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 Q <br /> BUILDINGS,ROADS,LAKE, LOT LINES. Q ; <br /> 5. 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 / <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN S <br /> NEEDED. Uj <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o tJ <br /> CONDITIONS OF PERMIT: �C <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ( I <br /> ISSUANCE. p <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. X758 <br /> mu 0 <br /> OidCD0. V <br /> 6. 2 3 nI yam <br /> v CN " o 3 <br /> 7. Z m o : 1 <br /> o 'nom <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofm sa <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognizem o m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- (D <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information 1 am d <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 above described premises at any reasonable time for the purpose of inspection. fD o <br /> CD <br /> (D <br /> SIGN HERE e' n <br /> (signature of owqpPeP4KiIdIng contractor) (date) <br /> anZONING ADMINISTRATOR ��t'✓ <br /> 0 fA 69MfA�N <br /> N f T N N 0 0 <br /> (TO (T Ut00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />