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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54172 Office of Zoning Administrator -V 0 (7- <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> N O <br /> N (Y� <br /> OWNER � Q -f'Zer TELEPHONE <br /> MAILINGADDRESS <br /> r <br /> 0 <br /> PROPERTY ADDRESS <br /> lv -� <br /> LEGAL DESCRIPTION(see tax receipt) I � <br /> 2 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION rn <br /> TYPE OFPERMIT(S): `v ' <br /> FILLINNFILLING/GRADING1:1CAMPING UNIT ElSUBDIVISION ❑ <br /> STRUCTURE/ADDITION USE:0 c $CiePry P"C 4 /a o <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) (n <br /> m <br /> BUILDING CONTRACTOR: io <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 S HEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> it m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o C <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n 3u <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDI 4GS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m 9 <br /> NORTH(N). Co <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BU LDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT O THE ORDINARY HIGH WATER MARK(OHWM)OF <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLj LIND AREAS. o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(S T)AND DRAINFIELD(DF),AND ALL DISTANCES TO <br /> BUILDINGS, ROADS, LAKE, LOT LINES. :E Q' <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED ANDS OW 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. F <br /> O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKEO SO AN ONSITE VERIFICATION MAY'gllf" WH N <br /> NEEDED. \' <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW d� . o <br /> CONDITIONS OF PERMIT: �� q� l <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT A/ C q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION ISR STRICTED ALONG SHORELINE.�O �'fC00iVC C <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOW D UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,AlLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 6. $ 3nmOx I;u <br /> O N C N N O <br /> 7. Z N N O <br /> o m <br /> I declare that this application (including any accompanying sc edule) has been examined by me and to the best of my p <br /> knowledge and belief it is true,correct and complete. I ackno edge that I am responsible for the detail and accuracy of m n v. <br /> all information contained in this application(including any acc mpanying schedule)and I further declare that I recognize m 0 0 <br /> that this information I am providing will be relied upon by the unty of Burnett Wisconsin in determining whether to is- <br /> sue a permit. I further accept all liability which may be a resul of the County of Burnett relying on this information I am m <br /> providing in this application. 1 agree to permit county official charged with administering county ordinances or other <br /> authorized person to have access to the above described prem es at any reasonable time for the purpose of inspection. - ° o <br /> CD m <br /> SIGN HERE ���/l02 `^ <br /> n : <br /> (signaturew ne-tbr buildontr ate) <br /> ZONING ADMINISTRATOR fi� ak <br /> ?/ <br /> fA 69 fA fv9 � N <br /> (T O U V• O O <br /> TOWNSHIP PE MITS N AY BE REQUIRED <br />