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�n COMPUTEPjSOm, ED <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,W154872 Office of Zoning Administrator v0 Z <br /> APPLICATION FOR LAND USE PERMITS 3 �� <br /> r <br /> to O ^ n <br /> OWNER TELEPHONE <br /> MAILINGADDRESS a�b 7j OI 0&4 /GB/ S ,ft // ` � ISMI o <br /> PROPERTYADDRESSyL� <br /> LEGAL DESCRIPTION(see tax receipt) S ?j $— 1(� m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE Lo ADDITION El U) 0 <br /> TYPE OF PERMIT(S): Q <br /> FILLING/GRA ING El CAMPING UNIT 1:1 SUBDIVISION cx c <br /> ❑ <br /> -Mp <br /> 2 �1 < <br /> STRUCTURE/ADDITION USE: Tl�l► Q`1'� 3Q X 301 <br /> me/Cabin;Commercial Business, Bedroom; Deck;etc.) ri) <br /> BUILDING CONTRACTOR: <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. m <br /> ° �U j <br /> H �) <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 O M <br /> � a <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m S <br /> NORTH (N). <br /> 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <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. 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. Q <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 ? o <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> o 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a o <br /> NEEDED. L 0Q <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 0 I <br /> CONDITIONS OF PERMIT: Q. <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. <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 /> M 0 g > 0 > 0 V <br /> 6. CD 0 3amxa � � <br /> m c N N p 3 <br /> 7. Z N N O <br /> T M <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 complete. I acknowledge that I am responsible for the detail and accuracy of m cA <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognizem 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 informationI am � G <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m = <br /> n <br /> �) m <br /> 0 <br /> SIGN HERE (LY`/C Q$ °�Ld' M : <br /> n : <br /> (signature own r or building contractor) (date) <br /> ZONING ADMINISTRATOR (� 11 L1 '^ <br /> f (A'A�+N <br /> fA <br /> N (T N N O O <br /> O 0010 00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />