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Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator ' o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> c <br /> /� �'1L/�-i n <br /> OWNER f --r(L , TELEPHONE �� - / ( V/ o <br /> CD 0 <br /> �0 OX n�uru V�l'IB�D <br /> MAILING ADDRESS f <br /> om <br /> PROPERTYADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) I —I l o I la .IJP 1 01 t/ (!J <br /> T 1 �l I <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE 1:1 ADDITION ❑ (A P <br /> TYPE OF PERMIT(S): n <br /> FILLINGG//GRRADDINLG ❑ CAMPING(UNIT ❑ SUBDIVISION ❑ <br /> c' <br /> STRUCTUREIADDITIONUSE: om-,L *l(L Q ) <br /> nip (Home/Cabin, Commercial Business; Bedroom; Deck;etc.) ( 7�5 <br /> BUILDING CONTRACTOR: `�l <br /> - <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p (D <br /> aI N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) OT o <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). (Cp o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m B <br /> v <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. Cr 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. V <br /> 5. 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. f 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 t� <br /> CONDITIONS OF PERMIT: 'r t <br /> (A 0 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT (n J <br /> ISSUANCE. I <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY O <br /> PERMITTED. 0 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> M <br /> Wr- 0a0 -0 <br /> m <br /> 6. <br /> 3 a m F nT. � <br /> Z R m o <br /> 7. o T'2 <br /> _ (�: m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my (j c' c <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of FIA: m n vi <br /> nom : v, : � <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize 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- <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 o0 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized p rson to haveaCcess to the above described premises at any reasonable time for the purpose of inspection. o <br /> m ' m <br /> SIGN HERE —'� a <br /> ature owner or building contractor) (date) <br /> ZONING 9 ADMINISTRATOR <n Pi <br /> N U N O <br /> L" OU O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />