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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 3. <br /> y O h <br /> N �J <br /> C M <br /> OWNER TELEPHONE v� /si_ 9 <br /> Q <br /> O <br /> MAILING ADDRESS rQ j F <br /> 0 CD <br /> PROPERTYADDRESS -7 1 <br /> LEGAL DESCRIPTION(see tax receipt) �— 3��/� rn <br /> CD <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURF� ❑ ADDITION ❑ 0 <br /> TYPE OF PERMIT(S): V Ll r/ ,;Z n <br /> FILLING/GRADING /ny. CAM7 PING UNIT 1:1SUBDIVI/yION L/,)Q` i "7- <br /> STRUCTURE/ADDITIONUSE: ` S/ / U ! <br /> (Home/Cabin; Commercial Business; Bedroo ; Deck;etc.) Ut(� �\ <br /> BUILDING CONTRACTOR: <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR _ <br /> T <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> :G m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) OT o �! <br /> ?t O 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)AND INDICATE <br /> NORTH(N). VCi v 0 <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 M Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. v3 a <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. t \� <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. f(v� rrrryyyy��v�`� <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC., THE PLANS W 1 <br /> MUST BE SIGNED AND DATED BY THE OWNER. c (w <br /> q Mv1 <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: <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 Q <br /> SETBACK AREA. <br /> 5. <br /> T <br /> Wa)0iCaOrC <br /> 6. $ B nm yam � Q <br /> N C N O <br /> N m O 1 <br /> I 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 of o 0 d, <br /> v, : A <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognia <br /> ze rr 1� o 0 0 <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- W <br /> L7 <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. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. o <br /> CD CD- <br /> SIGN HERE a <br /> (signatur ner or building cont r t ) (date) <br /> ZONING ADMINISTRATOR zvq <br /> QEfl EA FA fA� N <br /> N CT N N O O <br /> T WNSHIP PERMITS MAY BE REQUIRED <br />