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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v OZ <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> UF <br /> UF 0 <br /> OWNER TELEPHONE �-17SSQ--, c <br /> ID <br /> MAILING ADDRESS �� ///'1 0 <br /> 0 <br /> CD <br /> PROPERTYADDRESS <br /> LEGAL DESCRIPTION(see tax receiptfid) <br /> m <br /> m <br /> DWELLING/BUILDING GARAGE/ACCES ORY STRUCTURE ADDITION ❑ (� ' C o <br /> TYPE OF PERMIT(S): ``}� C <br /> FILL ING/GRFNG ❑ CAMPING UNIT ❑ $UBQIVISION a <br /> /��� <br /> STRUCTURE/ADDITION USE: V / T o_ <br /> l (Home/Cabin; Commerci Business; Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: ,Lt--)4 <br /> d <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n 3 3 <br /> M N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) Q <br /> n a <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> A d <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m CD <br /> NORTH(N). C n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m o <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. Zo <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 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE PLANS N <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN vo <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z l <br /> CONDITIONS OF PERMIT: .0 r, <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT W <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <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 /> 6. m m iu 0 C a <br /> 8 � 'nm yam <br /> Z7. N N o <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my —� : A <br /> knowledge and belief it is true, correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of m <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 relied upon by the County of Burnett Wisconsin in determining whether to is- m <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 d <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other r d <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. = <br /> m C/) <br /> -n 0 . <br /> N N <br /> SIGN HERE to <br /> (signature of owne r building contraa <br /> ct (date) (1' <br /> ZONING ADMINISTRATOR r <br /> _ 1 ER fA EA EA� N <br /> , N (T N NOO <br /> (TO (T (TOO <br /> TOWNS IP PERMITS MAY BE REQUIRED <br />