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ON COrVE!' q/ ^ INNED <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> C= <br /> (D <br /> OWNER (�� TELEPHONE 7i <br /> m <br /> MAILINGADDRESS <br /> r � <br /> 0 <br /> PROPERTYADDRESS <br /> �7 W <br /> LEGAL DESCRIPTION(see tax receipt) 4 Lo tc'►� I Cif 2-7 T.3f-;' !l '� � m <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ cn 0 <br /> TYPE OF PERMIT(S): Q <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) v h <br /> BUILDING CONTRACTOR: .Za ( vCD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n a� <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> (n a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 w <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m `° J <br /> NORTH(N). Cn o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO m B I <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF QQ 1 Z a <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. i o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO cn <br /> BUILDINGS, ROADS, LAKE, LOT LINES. " 1it <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS G <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN 0 4 <br /> NEEDED. O <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 (� C <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. W 1 4 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY ti <br /> PERMITTED. d <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. C <br /> 5. <br /> CD °C Wm 0 m <br /> 6. m xB am � a � ; <br /> o m C 'op <br /> o 3 <br /> Z c o i -1 <br /> 7. o m �� . <br /> = cn m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Q O <br /> knowledge and belief it is true, correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of w 0CL <br /> all information contained in this application (including any accompanying schedule)and I further declare that I recognize CD my <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- cn <br /> sue a permit. I further accept all liability which may be a result of the County of Bun I m o <br /> providing in this application. I agree to permit county officials charged with ad s c u <br /> authorized person have access to the a ove described premises at any reason I s i o `D o <br /> m <br /> m > : <br /> CD a <br /> SIGN HERE <br /> a : <br /> si�of building contractor) d (�� •, <br /> E <br /> ZONING ADMINISTRATOR <br /> BURNETT COUNTY <br /> sa`• v�v> <br /> -+EA Efl Efl ffl N <br /> O O N Cn W W <br /> ZONING N O <br /> TOWNSHIP PERMITS MAY BE REQUIRED NING CD cn C) Cn C" Cn C <br /> THIS PERMIT SHALL EXPIRE ON AR FROM DATE OF ISSUANCE <br />