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Office of Zoning Administrator CD G) 0 <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 % .- <br /> APPLICATION FOR LAND USE PERMITS N <br /> CL <br /> mi TE EPHONE <br /> OWNER 7 O? <br /> r <br /> 0 <br /> HOME ADDRESS <br /> ROAD NAME 1 <br /> EMERGENCY/FIRE NUMBER r , <br /> w co <br /> CN <br /> LEGAL DESCRIPTION(see tax receipt) I ur o <br /> ADDITION ❑ PRIVY ❑ c <br /> Cr <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE d < <br /> TYPE OF PERMIT(S): / �^ J/ 0 <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION J <br /> y <br /> STRUCTURE/ADDITION USE: (HomelCabi Commercial Business; B Broom; Deck;etc.) � <br /> BUILDING CONTRACTOR: v <br /> m <br /> X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> T 3 <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN SYi A c <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> n c <br /> T Z <br /> FO <br /> DIRECTIONS R PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n :0 <br /> M <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m �0 <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)T <br /> CENTERLINE OF ROAD,R ANDI DING(SR MES TO WETLAND AREAS.THE INARY HIGH WATER MARK(OHWM)OF c <br /> LAKE,STREAM OR RIVER `L <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRp INFIELD(DF),AND ALL DISTANCES o <br /> BUILDINGS,ROADS,LAKE,LOT LINES. pQ <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 0 o <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS . l <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATI <br /> NOTE: BUILDINGISTRUCTUREON MAY BE DONE WHEN a <br /> NEEDED. Z `l�} <br /> o <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. I <br /> CONDITIONS OF PERMIT: ,- a <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT \ <br /> ISSUANCE. v <br /> 2. REMOVAL OR 3. NO GRADING OR SHING OF TREES AND ORELAND ALTERATIONS ARE ALLOWEDUNLESS SPECIFICALLY SHORELINE. <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. m v m r in <br /> 5. C 6 v n N Q= ;a <br /> m co gg 3 <br /> N o =i6. o Nn� ! 70 <br /> - : In <br /> 7. c <br /> I declare that this application (including any accompanying schedule) has been examined by me and it the best ac o <br /> lcta and <br /> (including any accompanying schedule)and I further declare that I recognize j m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy recognize <br /> o.B <br /> all information contained in this app the County of Burnett Wisconsin in determining whether to is- <br /> that this information I am providing will be relied upon bytt <br /> sue a pnrmI am <br /> n•t�further li application. Iall <br /> ageeliability permk ounty offwhich may be a icials alssult ocharged w th admin staring Icounty tordinances his tornother <br /> providing m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> 40 <br /> (date) <br /> SIGN HERE (signature of ow er r building contractor) 40 <br /> \ . <br /> d,49 49 <br /> N N P N N u• 0 <br /> ZONING ADMINISTRATOR o c,o o 0 0 o <br /> 0000000 <br /> TOWN HIP PERMITS MAY BE REQUIRED <br />