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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator _U ci Z <br /> APPLICATION FOR LAND USE PERMITS . <br /> r <br /> y 0 <br /> CD <br /> �'�j CL <br /> N <br /> OWNER ; �t.Lr A� TELEPHONE IrO <br /> MAILINGADDRESS PW J , 0 <br /> i o <br /> PROPERTY ADDRESS (//�' // I /// <br /> LEGAL DESCRIPTION(see tax receipt) Cn <br /> m <br /> A <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ <br /> TYPE OF PERMIT(S): FILLING/GRADING UNIT SUBDIVISION N+ Q0STRUCTURE/ADDITIONOSE: ❑ en aqy <br /> ( e/Cabin; Commercial Business;Bedroom; Deck;etc. rn <br /> m <br /> BUILDING CONTRACTOR: )V I <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81A 11 SHEET OF PAPER. ANY INCOMPLETE OR m3 <br /> ILLEGIBLE_ PLOT PLANS WILL BE RETURNED. r <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AE RIAL OR TOP VIEW) O m <br /> -n a <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n 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). i y o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOL OWING: (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 <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO Co <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 B AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE PLANS K <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> I O 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS ANUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN 0 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITION LISTED BELOW. o I Q <br /> CONDITIONS OF PERMIT: Ln <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATI NS 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. mOdoMa �0) m <br /> U N CD 3 Ox <br /> C <br /> 7. Z N co O <br /> O T .Z1 <br /> I declare that this application (including any a companying schedule) has been examined by me and to the best of my — �^ A <br /> knowledge and belief it is true,correct and co plete. I acknowledge that I am responsible for the detail and accuracy of m n Fn c <br /> PP ( 9 Yaccompanying ) g ate ' <br /> all information contained in this application In ludin an schedule and I further declare that I recognize m o : m <br /> that this information I am providing will be reli id upon by the County of Burnett Wisconsin in determining whether to is- 0 <br /> sue a permit. I further accept all liability whict may be a result of the County of Burnett relying on this information I am m <br /> providing in this application. 1 agree to permit county officials charged with administering county ordinances or other ' o <br /> authorized person to have acces the above described premises at any reasonable time for the purpose of inspection. T (D <br /> CD o : <br /> CD <br /> SIGN HERE t �" Z <br /> a : <br /> (signature of owner or building contractor) I (date) (� <br /> ZONING ADMINISTRATOR 1 <br /> P39 <br /> 69 <br /> "j v+ O N 0 O <br /> TOWNSH�P PERMITS MAY BE REQUIRED �J <br />