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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator M o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r- <br /> N <br /> N <br /> OWNER TELEPHONE <br /> m <br /> MAILINGADDRESS — <br /> r m <br /> o <br /> PROPERTYADDRESS (� , <br /> LEGAL DESCRIPTION(see tax receipt) -� - 12)7 IX 0a <br /> m <br /> TYPE OF PERMIT(S): <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTUR ADDITION ❑ (n <br /> Q <br /> FILLING/GRADING ElPPIING UNIT ❑ SUBDIVISION <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commerclal Business;Bedroom; De ;etc.) v> <br /> BUILDING CONTRACTOR: m <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AE RIAL OR TOP VIEW) O a <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL XISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). N 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) EASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF Z <br /> LAKE,STREAM OR RIVER AND MEASUR MENT 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. \> <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N ( 1 I <br /> 6. IF SEPARATE PLANS ARE SUBMITTED B AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE PLANS 0 if <br /> MUST BE SIGNED AND DATED BY THE 01 VNER. o <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: o �4 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDT A REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND V EGETATION 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 C <br /> SETBACK AREA. <br /> 5. <br /> X <br /> d m > O O -0 <br /> 6. CD amM <br /> v' CD 0 � 3 <br /> 7 Z <br /> . in � o <br /> o T <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 co plete. 1 acknowledge that I am responsible for the detail and accuracy of w 69 <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o m <br /> that this information I am providing will be rel ed upon by the County of Burnett Wisconsin in determining whether to is- CD O <br /> sue a permit. I further accept all liability whit i may be a result of the County of Burnett relying on this information I am m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. �. (D o <br /> CD <br /> CD m' <br /> SIGN HERE "' o <br /> (signature of ow or uilding contractor) (date) <br /> ZONING ADMINISTRATOR <br /> fA EA fA fA � N <br /> TOWNSH PERMITS MAY BE REQUIRED G) <br />