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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 'D o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> - r <br /> N 0 <br /> GNMIER C�C S19" <br /> TELEPHONE 1 p <br /> MAILINGADDRESS '-ane, h4n ( � O <br /> �7 m <br /> PROPERTYADDRESS 3o 7r/ �Y .S�rL Kll I o <br /> LEGAL DESCRIPTION(see tax receipt) <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION to O <br /> TYPE OF PERMIT(S): Q <br /> FILRADI G ❑ CM//PIN U ' <br /> LW <br /> NIT f❑ SBD/IVI�SION ❑ �' <br /> STRUCTURE/ADDITION USE C� W 5 ten q- <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) v <br /> BUILDING CONTRACTOR: io <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED O AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> /ZJ N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 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 INDICATE <br /> NORTH(N). y 3 <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. 19 <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. O <br /> S. 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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. a <br /> v � I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <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 C <br /> ISSUANCE. W <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 1 <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 h��( <br /> SETBACK AREA. <br /> 5. <br /> X nOi r- > 0Da l73 <br /> W, <br /> 6. 3 n m `R T � <br /> O N C y N O j i <br /> 7. N n1 O <br /> T� m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of o C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m o my <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- i i A <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 permit county officials charged with administering co my ordinances or other <br /> authorized persoryto have acceAs to the a o escribed premises at any reasonable time fort pujpose of inspection. - ° o <br /> CD <br /> CD m : <br /> SIGN HERE <br /> a <br /> g ture f ow r uilding contractor) /( ate) /1\ <br /> V: <br /> ZONING ADMINISTRATOR CQ <br /> " fA fA fA(A N <br /> j I�Jcc- <br /> N (T NNOO <br /> CTOU10100 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />