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Burnett County 7410 Co. Rd. K, No. 10 ,Siren,WI 54872 Office of Zoning Administrator T o o <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> - r <br /> y O <br /> N <br /> C <br /> OWNER n TELEPHONE <br /> v <br /> d <br /> m <br /> MAILING ADDRESS qO <br /> ,' / <br /> PROPERTY ADDRESS aE�y .,4-. / - <br /> _v !92111j734n <br /> LEGAL DESCRIPTION(see tax receipt)S y N Y �>`!LSY S F Xvi✓ N U <br /> TYPE OF PERMIT(S): <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE 1:1 � <br /> ADDITION ❑ ( U< <br /> O <br /> FILLING/GRADING ❑ IC MPING UNIT 0 SUBDIVISION ❑ ,( 4 <br /> STRUCTURE/ADDITIONUSE: B n 42 A -lt� to _ ^ <br /> o_ <br /> ( ome/Cabin; Commercial Business;Bedroom; Deck;etCn <br /> . <br /> S ?p <br /> BUILDING CONTRACTOR: C- - <br /> d <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR m <br /> w <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T 30 <br /> �I N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p <br /> -n 0- <br /> Z! <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> mm d A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). C S n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOL OWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <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 <br /> BUILDINGS, ROADS, LAKE, LOT LINES. O> <br /> 5. INDICATE IF A WALKOUT BASEMENT IS P ANNED AND SHOW AREAS TO BE GRADED OR FILLED. N 1 <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. i <br /> f <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS N UST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: <br /> P <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTF REQUIREMENTS WITHIN 60 DAYS OF PERMIT ( 4 <br /> ISSUANCE. I ri <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. I . <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY w <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> m 0 >0>0 -V <br /> 6. CD <br /> 7. C y N O j 3 <br /> Z R N O _ to <br /> T`< ;a <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my - CTCT a A <br /> knowledge and belief it is true,correct and con plate. I acknowledge that I am responsible for the detail and accuracy of I cen c <br /> all information contained in this application(in luding any accompanying schedule)and I further declare that I recognize (D o m <br /> that this information I am providing will be relic d 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 of Burnett relying on this information I am o� <br /> providing in this application. I agree to permil county officials charged with administering county ordinances or other 01 <br /> authorized person to have access to the above fescribed premises at any reasonable time for the purpose of inspection. M s <br /> . rn <br /> (D o : <br /> SIGN HERE ei <br /> a <br /> (signature of owner d c a o (dat <br /> ZONING ADMINISTRATOR <br /> C) � cNnoo <br /> TOWNSHIPPERMITS MAY BE REQUIRED <br />