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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 3. <br /> N <br /> C <br /> N <br /> OWNER TELEPHONE /r , ��- O <br /> MAILING ADDRESS � f <br /> o � <br /> PROPERTYADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) <br /> m <br /> 4 <br /> DWELLING/BUILDING ❑ GARAGEIACCESSORY STRUCTURE ❑ ADDITION ❑ (A <br /> TYPE OF PERMIT(S): rr Q I <br /> FILLING/G DING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ r <br /> STRUCTURE/ADDITION USE: 0 , <br /> (Home/Cabin; Commercial Business;/ Bedrobm, Deck; etc.) to Q m <br /> BUILDING CONTRACTOR: w <br /> m <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> M N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a <br /> 'n o Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m � <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <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 Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT 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 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. f <br /> O W <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. O <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: C3 <br /> Y <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. o <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 /> 0 C M 0 0 a : m <br /> 6. m x3 am yam .� <br /> o m C <br /> 7. m o �o —{ <br /> O N T� m <br /> Cn <br /> I declare that this application (including an accompanying schedule has been examined b me and to the best of m — A <br /> PP (� 9 Y Y 9 ) Y Y <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of d n <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m <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 O <br /> CD <br /> providing in this application. I agree to permit ty officials charged with ad ml I o er o <br /> authorized crso to have s to the above e c bed premises at y reason' l %r h o f e I m ° a <br /> N D i <br /> SIGN HE E a <br /> JUN 2 2 <br /> i - si natur wne�orbui incontractor n( 0 <br /> ZONING A INISTRATOR <br /> BURNETT COUNTY " ) EA ffl `" <br /> . . 6 N <br /> O N Ul W W N O <br /> TOWNSHIP PERMITS MAY BE REQUIRED ZONING <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />