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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v 0Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r 0 \ <br /> N Irk <br /> C <br /> N <br /> d <br /> OWNER P���t TELEPHONE (> <br /> MAILINGADDRESS <br /> r m <br /> PROPERTY ADDRESS <br /> �as7 r�-Q Id ed <br /> LEGAL DESCRIPTION(see tax receipt) <br /> DWELLING/BUILDING GARAGE/ACCESSORY/STRUCTURE ❑ ADDITION ❑ I 0 <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> aoo� '7-n I-h al y <br /> STRUCTURE/ADDITION USE: 9 � D o' <br /> (Home/Cabi , ommercial Business;Bedroom; Deck;etc.) (n ra, <br /> BUILDING CONTRACTOR: <br /> 4 <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'h X 11 SHEET OF PAPER. ANY INCOMPLETE OR � <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> O <br /> M ` <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O <br /> n n <br /> In Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n 00 X <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF C, <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. W O <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 THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. / o t <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION Y BE Dtf� U� <br /> NEEDED. C�\/ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: � <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. OAC <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. VV , & <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. (��/ <br /> (�� A or, DOD0 -U <br /> 6. �' 3 am xnm <br /> O m C y y O j 3 <br /> 7. Z N N O _ 4 <br /> G n� <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my — A <br /> ( n c C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of G <n <br /> PP (including Yaccompanying 1 g a M <br /> all information contained in this application Includin an schedule and I further declare that I recognize C o : m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m <br /> sue a permit. 1 further accept all liability which may be a result of the County of Burnett relying on this information I am w <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or otherco <br /> 9 <br /> 0 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> m o : <br /> (D m <br /> SIGN HERE <br /> (s n ure of own uilding contractor) (date <br /> ZONING ADMINISTRATOR Zvi <br /> t/��/ p <br /> (j, 1 -' o fA fA di fN a N <br /> k N ON N N O O <br /> (TOUT (TOO <br /> TOWNS IP PERMITS MAY BE REQUIRED � � Q <br />