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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATIO FOR LAND USE PERMITS g. <br /> m O ^ <br /> C <br /> d <br /> OWNER TELEPHONE���� J <br /> v <br /> o� <br /> MAILINGADDRESS / Q, ,e 1� <br /> ( 0 <br /> PROPERTYADDRESS s, <br /> LEGAL DESCRIPTION(see tax receipt) C �/ �lC ��.L��-� 1Cn <br /> DWELLINGIBUILDIN GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ rn <br /> TYPE OF PERMIT(S): v <br /> FILLING/GRADING ❑ C MPING UNIT ❑ SUBDIVISION ❑ �` ��,. <br /> 1 y <br /> STRUCTURE/ADDITION USE: 0 <br /> (Home/Cabin; Commercial Business;Bedroom; Deck;etc.) U <br /> BUILDING CONTRACTOR: <br /> 1 <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> ,n y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) OT n <br /> T o Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 9 A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). y o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOL OWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S) AEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF Z <br /> LAKE,STREAM OR RIVER AND MEASURE 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. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED B AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE PLANS 0 ` a <br /> MUST BE SIGNED AND DATED BY THE OWNER. o �� <br /> o ' j <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 <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDT REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. UJ <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 <br /> SETBACK AREA. <br /> 5. (yC <br /> DOD <br /> � or <br /> 6. <br /> 6. $ <br /> 3 nm � a D .'0 <br /> N C N N O j 3 <br /> Z H N O <br /> I declare that this application (including any iccompanying schedule) has been examined by me and to the best of my ( o Cj C <br /> knowledge and belief it is true,correct and co plete. I acknowledge that I am responsible for the detail and accuracy of C 2 <br /> all information contained in this application(h icluding any accompanying schedule)and I further declare that I recognize m o mo <br /> that this information 1 am providing will be rel ed upon by the County of Burnett Wisconsin in determining whether to is- <br /> m <br /> sue a permit. I further accept all liability whic 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 perrr it county officials charged with administering county ordinances or other 01 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. `D o <br /> r ; 7 <br /> SIGN HERE <br /> ( gna re of owne or building co tctor) r (date) <br /> ZONING ADMINISTRATOR <br /> Efl fA EA EH 0 N <br /> N N N N O O <br /> Vt O01 (rOO <br /> TOWNS IP PERMITS MAY BE REQUIRED <br />