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Burnett County 7410 Co.Rd.K,No.102,Siren,WI 54872 Office of Zoning Administrator v 0 z <br /> APPLICATION FOR LAND USE PERMITS <br /> N G <br /> T'T 67L-WE7t1 I'tAKeAJ TE�PHONE 49:Z o - 41a7- �i� <br /> MAILINGADDRESS /20 // /(l0a47ff #e19AAVgk <br /> r <br /> O 1 <br /> PROPERTYADDRESS 3 1 / ) �. m <br /> LEGAL DESCRIPTION(see tax receipt) St <br /> DWELLINGIBUILDINGEl❑ GARAGE/ACCESSORY STRUCTURE ADDITION m <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT SUBDNISFL <br /> ION ❑ <br /> STRUCTURFJADDmON USE: yAnl* )P'1�2 <br /> , <br /> (Honie/CJ1binjC0n>M9fCiaI Business;Bedroom;Deck;etc.) <br /> m <br /> BUILDING CONTRACTOR: I m <br /> U <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 0%X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> M w <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 <br /> T z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN 70 SCALE. m � jp <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO fyll 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. P <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO d <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 7• <br /> MUST BE SIGNED AND DATED BY THE OWNER. 0 <br /> o � <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT �U�•ll ((/�� <br /> ISSUANCE. 7n <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 og> D <br /> 6. sL <br /> 7. Z ago ; ?Qn <br /> P �Q m <br /> 1 declare that this application(including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief It Is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of c� « <br /> all Information contained In this application(including any accompanying schedule)and I further declare that I recognize f m o v <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 O <br /> p p ty y ty y ng on this Information I am m <br /> providing in this application. 1 agree to permit county officials charged with administering county ordinances or other '010 <br /> authorized person to have access to the above described premisoj4t any reasonable time for the purpose of Inspection. a' <br /> SIGN HERE !o% r ~ ` <br /> Z : <br /> (signature r or Ilding contractor) (date) ' <br /> ZONING ADMINISTRATOR j!/Y1� <br /> 1q. p NN <br /> �j,�cf� NOOS <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />