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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 /> OWNER TELEPHONE <br /> MAILING ADDRESS m <br /> 0 <br /> E <br /> PROPERTYADDRESS <br /> o m <br /> LEGAL DESCRIPTION(see tax receipt) /SE <br /> W <br /> TYPE OF PERMIT(S): DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE LJ ADDITION LJ o' _ <br /> c � <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBION n <br /> STRUCTURE/ADDITION USE: \� `- <br /> ) S �x Lll N <br /> 0 <br /> (i-lomei[,abin, Commercial Business,B Broom; Deck;etc.) <br /> BUILDING CONTRACTOR: <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 17 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> T <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING, (AERIAL OR TOP VIEW) M <br /> O <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n v Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE A <br /> NORTH(N). m <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 v <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. Z <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 /> S. 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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. =° <br /> r, <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o IjJ <br /> NEEDED. <br /> n <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. I <br /> CONDITIONS OF PERMIT: Z Q <br /> 0 <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 /> 5. <br /> 6. <br /> m on�0MaFm <br /> 3o. c� a <br /> mrx ^ mom <br /> Z ^ m o ' 1 <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my o 0 <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of (,, m c'cc m <br /> v O C <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize ``. m ; , 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 : 0 <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 m <br /> providing in this application. 1 agree to O <br /> authorized person to have access t o the above described premises at any1reason reaith sonable <br /> for the purpostering county se of inspectioes or hn.r <br /> m U) <br /> -n <br /> SIGN HERE m m <br /> d : <br /> (signature of owner or build contractor) ' <br /> (date) a <br /> ZONING ADMINISTRATOR <br /> N (T N N p <br /> TOWNSHIP PERMITS MAY BE REQUIRED p <br /> (� `� `� w o 0 <br />