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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 0 Z <br /> APPLICATION FOR LAND USE PERMITS 3° <br /> r <br /> y O <br /> H <br /> OWNER X ,dl TELEPHONE <br /> 7 O 1 � �� ' � <br /> HOME ADDRESS `' UA O <br /> EMERGENCY/FIRE NUMBER ROAD NAME .. <br /> i <br /> 3S- � <br /> LEGAL DESCRIPTION (see tax receipt)UL q)- l,� �� /U& s ) rn <br /> TYPE OF PERMIT(S): <br /> DWELLING/BUILDING 1:1GARAGE/ACCESSORY STRUCTURE ElADDITION El PRIVY ❑ y ' <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISIONS <br /> Csmy >� -�- 9 N <br /> STRUCTURE/ADDITION USE: Co <br /> (Home/Calm; Com ercial Business; Bedroom;Deck;etc.) rn <br /> BUILDING CONTRACTOR: RA <br /> e <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 77 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. �I <br /> c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p <br /> TZ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. , <br /> m <br /> NORTH <br /> 2 THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> ( ) C 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. <br /> S. 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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN 0 o N <br /> NEEDED. c <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> i <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT I <br /> ISSUANCE. 1N <br /> I <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> W <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY 01 <br /> PERMITTED. I <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER h O <br /> SETBACK AREA. I I <br /> 5. <br /> _�ma m r ( O 17 <br /> 6. , 'D, a im I� <br /> `G C y y O 3()V <br /> 7. Z ; y0o 'n —I <br /> O Q x <br /> _ m• m <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my . p <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize ( !D <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- \ p <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 application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection <br /> (o <br /> SIGN HERE <br /> a : <br /> (signatur of owner or buildin c trnctorr)) ' (date) <br /> ZONING ADMINISTRATOR <br /> 64 4A <br /> N NGnNNfn In <br /> N NON VIOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />