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BurnettCounty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator _ 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> N � <br /> N <br /> C <br /> d <br /> OWNER j�'� TELEPHONE o <br /> HOME ADDRESS _ v <br /> EMERGENCY/FIRE NUMBER (� ROAD NAMES ) <br /> LEGAL DESCRIPTION see tax receipt) <br /> ar <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE 1-1ADDITION El PRIVY PRIVY ❑ i rn � <br /> TYPE OF PERMIT(S): it / <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISIO_*N <br /> STRUCTURE/ADDITION USE: 020 N LU <br /> (Ho a/Cabin ommercial B sine s; Bedroom; Deck; etc.) rn <br /> m <br /> n <br /> BUILDING CONTRACTOR: /( <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/s X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> M N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m :° <br /> NORTH(N). Cfn <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 <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 <br /> BUILDINGS, ROADS,LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N (a <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 C Vr lJ <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHENq 0 <br /> NEEDED. <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 IlAvvnnV`iilll <br /> ISSUANCE. <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. f <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> Q nW oDav '0 �i <br /> CMD CP =1 <br /> 7. <br /> —rn m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my (j c p <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of o C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- D <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 m <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. T <br /> m : <br /> CD : <br /> SIGN HERE <br /> (signse f owner or building co cto (date) <br /> pr <br /> ZONING ADMINISTRATOR >Irj IFn <br /> En En Fn er w fn <br /> N NO (N71 V1 N O N ON <br /> UI <br /> OWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br /> 0000000 <br />