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Burnett County 71110 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> - r <br /> OWNER TELEPHONE 7�s�y9z i 2 O <br /> HOME ADDRESS 'X /�� �fi(G���A// 9 <br /> EMERGENCY/FIRE NUMBER �oo 'zo ROAD NAME` <br /> f <br /> 0- <br /> LEGAL DESCRIPTION(see tax receipt) 0� co <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ rn 0 <br /> TYPE OF PERMIT(S): Q <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION C� o` <br /> STRUCTURE/ADDITION USE: / /�f�/r r/eG/C /1/CNt/ D� f yyY ,© � %r'/����� 0 �- <br /> Cq <br /> (Home/Cabin; Commercial Busine s; Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: • Y/� Eu <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). W <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m (� B <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF " t 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 O <br /> BUILDINGS,ROADS,LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. lv <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. m' <br /> o 0 R <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN Ct ° " I <br /> NEEDED. a <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 <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG S E. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIF r 1 <br /> PERMITTED. Q , <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN REQUI / �✓ <br /> ( T <br /> s. � <br /> � � 0oi m O � OvjRK Yzb _ rs <br /> 6. ° v�-- '0 <br /> _� � <br /> C <br /> 7. 2p Cp o : i i i i <br /> A <br /> I declare that this application (including any accompanying schedule) has been examined by nd tIre best of my E G3 c ; ` ; IS <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of o 0 <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize mm ? ? m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m O <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 /> providing in this cation. a to permit county officials charged with administering county ordinances or other m <br /> authorized p, 96 to ave ess to the above described premises at any reasonable time for the purpose of inspection. T <br /> CD <br /> SIGN HERE � � <br /> (sl ure of ownsar building contractor) (date) <br /> ZONING ADMINISTRATOR w <br /> www w w <br /> N N 0 R N N P <br /> CA V7 O U1 U1 O O <br /> 0000000 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />