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Office of Zoning Administrator - o 0 <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 3 0 <br /> APPLICATION FOR LAND USE PERMITS c s <br /> f �O-n Atb(,� TELEPHONE o <br /> .1/ = w <br /> OWNER <br /> MAILINGADDRESS �`J�f (p ��V rn /7 ✓� ' �� Vl`S ' " - � <br /> PROPERTY ADDRESS ^ / C \ <br /> �/ S� /V G CD <br /> C <br /> LEGAL DESCRIPTION(see tax receipt) Lam/, �� gCY�_V G] c�� 7 C C <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION <br /> ❑ �7 �// /� Uj v, ° <br /> TYPE OF PERMIT(S): n ?' <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION <br /> CS60--&/ o <br /> STRUCTURE/ADDITION USE: m <br /> Q (Home/Cabin;Co mercial Business,Bedroom,Deck,etc.) <br /> BUILDING CONTRACTOR: <br /> 1 � �� „ u Off}4 Ll <br /> v <br /> M <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 84A X 11 SHEET OF PAPER. ANY INCOMPLETE OR n 3. <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. in <br /> O n <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) nZ <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 C 0 <br /> NORTH(N). m O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF c <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. N <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS <br /> 2. <br /> MUST BE SIGNED AND DATED BY THE OWNER. p <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> o <br /> NEEDED. <br /> Z v <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. ° I <br /> CONDITIONS OF PERMIT: Q <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. <br /> 2.3. NO REMOVAL OR <br /> OR CUTTING OF TREES AND <br /> ELAND ALTERATIONS ARE ALILOWEDIS TRICTED ALONG UNLESS SPEC F CALLLLINE. <br /> Y <br /> PERMITTED. <br /> 4, NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 3 n' F <br /> 6. m T N �J` <br /> Z p u1 <br /> ° T ` m <br /> 7. =� A <br /> I declare that this application(including any accompanying schedule) has been examined by me and to the best of my r1. 0, . <br /> l/v 8 C <br /> m = o m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of iu 8 Fn <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- C <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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other ti <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. - o <br /> M <br /> m : <br /> C : <br /> CL <br /> SIGN HERE <br /> (signature of ow r or building contractor) (date) <br /> ZONING ADMINISTRATOR <br /> N (TNN O O <br /> (T O CT IT O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />