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Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator vci Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> m O <br /> `71S- 7'— � <br /> Q"�f/ �/�Q/� h� �� � ` <br /> OWNER �-d— , /ar �/l_ TELEPHONE n <br /> l�(1 � W <br /> L3 V Ate, �/�'dY2 <br /> MAILING ADDRESS � oZ � F <br /> PROPERTYADDRESS <br /> �a -44 <br /> LEGAL DESCRIPTION(see tax receipt) �/ m <br /> tv <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ , (n 0 <br /> TYPE OF PERMIT(S): gn G,. 1/1 or <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION /�" o' <br /> c <br /> STRUCTURE/ADDITIONUSE: 1T[ /r /�L/ 0 <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) ob- <br /> I� m <br /> BUILDING CONTRACTOR <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p <br /> n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n d TI Z Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <br /> 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 --' -o <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 GI <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. I <br /> 0 <br /> q j X1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN � o <br /> NEEDED. <br /> 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT t <br /> ISSUANCE. Q <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 C" <br /> SETBACK AREA. <br /> 5. c <br /> 3a(OD Ox a1 <br /> NCN '^ o S3 <br /> 7. <br /> p 21 i MM <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my t7 c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of i'u <br /> CL <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- l <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 <br /> ! m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other Q� <br /> - <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. U) :� . I <br /> m <br /> m 0 :c : <br /> SIGN HERE d' <br /> (signature of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR <br /> V O NN N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> O O(TNOO <br />