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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 %;. .I <br /> r <br /> o (� <br /> ry� /� n " 1 <br /> OWNERI11V— A L TELEPHONE <br /> j©QY)')19Y1 TELEPHONE <br /> � O <br /> MAILINGADDRESS 13 • 1t) CD <br /> PROPERTY ADDRESS <br /> `7 W n z-,r R �l <br /> LEGAL DESCRIPTION(see tax receipt) NZ-V9 -.)t �/Q Al*l j <br /> M <br /> DWELLING/BUILDING V1 GARAGE/ACCESSORY STRUCTURE ADDITION ❑ rn ° <br /> TYPE OF PERMIT(S): v <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: ome ctole _she-;J 0 <br /> N ,'6� <br /> (Home/Cabin; Commercial Business;Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: <br /> v <br /> M <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> M w <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) OT a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m o A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATEAS <br /> NORTH(N). y <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 <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. ° <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 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. 'o f <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. 2 <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 <br /> SETBACK <br /> �AREA. <br /> (�� ,y�y� J <br /> 5. See, eb 1`." / �� � ti If�,�l I� <br /> M nni r > 0a0 -0 <br /> M <br /> � 3 nm �. am � <br /> 6. m <br /> O N C y O <br /> 7. Z in - oi : <br /> o Trn <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my A <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m <n <br /> n ^� : : <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m � 0 o m: m <br /> o <br /> that this information I 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- f'Bur @ ilinp g h inns information I am m <br /> providing in this application. I agree to permit county officials charged,wtth-111 ring fy=ordinances or other <br /> authorized person to have c ss to the abo described premises at any reaso li. im r e purpose of inspection. m o <br /> SIGN HERE AP 2 <br /> n : <br /> (signature of owner or building contrator) Lj [date) <br /> ZONING ADMINISTRATOR ��R1 (J BURNETT COUNTY <br /> JJZONING N ( N o 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />