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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator -U o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> w O <br /> N <br /> /�� a <br /> OWNER `i //// C/�"/���0 TELEPHONES-- 7� a1 C <br /> MAILINGADDRESS <br /> PROPERTYADDRESS (� <br /> LEGAL DESCRIPTION(see tax receipt �� f C a8uA/L / ` 1 <br /> 2 <br /> DWELLING/BUILDING V GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ p> <br /> TYPE OF PERMIT(S): Q <br /> FILLING/�DING�/,, ,CLAMPING UNIT ❑ SUBDIVISION ❑ - n 5. <br /> T. <br /> STRUCTURE/ADDITION USE: .1_Jj,II� �/!1�Y /l_����UX� C�1( o <br /> �� (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) U <br /> BUILDING CONTRACTOR: ( <br /> J v <br /> M <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 o <br /> T O z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. (� m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m M- <br /> NORTH(N). y 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <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. 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. I <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 1 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC., THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> / o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN - S <br /> NEEDED. ^ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z <br /> 0 <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT I <br /> ISSUANCE. C\ <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. r-y <br /> 5. <br /> � r0oQov <br /> m <br /> 3 'am x T � <br /> 6. v mC0v0 � 3_ <br /> 7. Z rn m O —{ <br /> O T Z <br /> rn <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ! <br /> � c C10 <br /> _ <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m n d,, <br /> o. ; v : � <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m O . my <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> sue apermit. I further accept all liability which y be a result of the County of Burnett relying on this information I am /^ m <br /> providing in this ap lication. I agree to pe unty officials charged with administering county ordinances or other v ' <br /> authorized pehave accea§s the ab s 'cribed premes at any reasonable time for the purpose of inspection. T I . o <br /> rson <br /> CD <br /> SIGN HERE <br /> a : <br /> (signature of owner ilding contractor) ( e) <br /> ZONING ADMINISTRATOR ryl ' <br /> ur yr <br /> EA fA EA N <br /> N U t N N O O <br /> (TO (T Ut 00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />