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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v G) Z <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> _ r <br /> c <br /> OWNER S � Q TELEPHONE �p I Z <br /> HOME ADDRESSU e eV\ J 0. <br /> EMERGENCY/FIRE NUMBER ROAD NAME e6y j LaVa- r��Y <br /> I <br /> LEGAL DESCRIPTION (see tax receipt) <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ff ADDITION ❑ PRIVY ❑ yT) 0 <br /> TYPE OF PERMIT(S): <br /> Q <br /> FILLING/GBADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ °4 <br /> STRUCTURE/ADDITION USE: <br /> _ n(Home/Cabin; Commercial Business; Bedroom;Deck; etc.) Cl) <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 n <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O <br /> In <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m a <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C <br /> NORTH(N). y 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <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. <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. <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. ('o <br /> o � n <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q ° ` <br /> NEEDED. ° J <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT; d <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. l <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. <br /> 5. lami �- _T' L <br /> `2 3 n9 <br /> 6. cu g 5' s <br /> 7. o m1`z ' <br /> _w; : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c <br /> knowledge and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of ? o ? E <br /> all Information contained In this application(Including any accompanying schedule)and I further declare that I recognize <br /> M <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Is- O <br /> sue a permit. I further ac apt all liability which may be a result of the County of Burnett relying on this information 1 am w <br /> providing In this applion. I agree to permit county officials charged with administering county ordinances or other m <br /> c <br /> authorized person to h e ccess to above described premises at any reasonable time for the purpose of inspection. <br /> CP : <br /> m : <br /> SIGN HERE 6AZ2 2 <br /> (sign ureofow rorbulldl ntractor) (date) <br /> ZONING ADMINISTRATORfn <br /> Im 6944600 44 4W <br /> N N(71N N(A pi <br /> VI (r1 0(T 571 0 0 <br /> CD 0 o o 0 o o <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> 0000000 <br />