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Office of Zoning Administrator o 0 <br /> Burnett County 7410 Co.Rd. K,No. 102, Siren,WI 54872 <br /> APPLICATION FOR LAND USE PERMITS <br /> 1J �/y� TELEPHONE S .0 / 0 <br /> CVMER n �-v V / � � � m O <br /> m <br /> r � <br /> MAILING ADDRESS � o <br /> PROPERTYADDRESS �(-1IYl '�+ 'V - <br /> ( I Q <br /> LEGAL DESCRIPTION(see lax receipt) 1 0 <br /> DWELLING/BUILDING ❑ GARAGEIACCESSORY STRUCTURE ADDITION LJn 0 <br /> TYPE OF PERMIT(S): `- <br /> FILLINGIGRADING ❑ CAMPING UNIT SUBDIVISION ❑ o <br /> �DI� (tii /�1-P �� �S��CL✓Q��� CCr��A�� <br /> STRUCTUREIADDITION USE: o' <br /> (Home/Cabin; Commercial Business; Bedroo eck; etc.) m <br /> BUILDING CONTRACTOR: <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN B%X 11 SHEET OF PAPER. ANY INCOMPLETE OR n 3 C <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. A m <br /> O C <br /> DIRECTIONS FOR OT PLAN DRAWING' (AERIAL OR TOP VIEW) <br /> PLT O Z <br /> n d A <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 N ` o <br /> 3 <br /> m <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF ` o <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. AND ALL DISTANCES TO <br /> 7n O <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF), `i' <br /> BUILDINGS,ROADS, LAKE,LOT LINES. o <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. i <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. o I� <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN ^. <br /> NEEDED. Z 1 <br /> o <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: <br /> 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT � Q <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 ID \J <br /> PERMITTED. r. n' ,11..c "'ITWIM TWc RFh1 ImPn WATFR <br /> 4. NO STRUCTURES, INCLUDING RE This structure to be Used as private residential <br /> SETBACK AREA. garage/storage only. Not to be Used for human <br /> 'U cM � <br /> W W 0a* m <br /> 5. habitation. 3N N o 3 <br /> 6. ^ '0 C O i =m 1 <br /> O D T : m <br /> 7. <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my d <br /> P m <br /> of <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy recognize <br /> m i to <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I then to ze o\x. O s <br /> that this information I am providing will be relied upon by the County C Burnett Wisconsin in determining whether to m 1" o <br /> sue a permit. 1 further accept all liability which may be a r suit of the County of Burnett relying on this Information I am <br /> ith admi <br /> providing in this applhavti access re M over deocr beunty d remises atganyed vreason reasonable time or the purpose of inspectionstering county ordinances or . Tt m ` n <br /> � v5 1 > : <br /> authorized pe _ ; a : <br /> SIGN HERE (date) <br /> (/ ,1 E <br /> (signature of owner or building contractor) <br /> ZONING ADMINISTRATOR <br /> QO� OfTNNO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THI RMIT S L E IRE OIJE. EA BOOM pATE�F�SSUANCEu /k <br /> m)T I? -p✓ Pi y / 7 LO GL <br />