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6-hm2t�o <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS I T_ <br /> 1 <br /> / <br /> OWNER TELEPHONE o s <br /> HOME ADDRESS � � e 6 <br /> EMERGENCY/FIRE NUMBER ( <br /> ROAD NAME h 0 Cl- e6 V 1 _ <br /> LEGAL DESCRIPTION(see tax receipt) <br /> GS ciCn i ri u (b� Cn <br /> STRUCTURE � ADDITION PRIVY ❑ <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY � 0 <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> e , � 6x �{�� fi <br /> STRUCTURE/ADDITION USE: 1C, rn <br /> 0 <br /> (Ho <br /> nabin, Commercial Business; Bedroom; Deck;etc.) <br /> Cn <br /> BUILDING CONTRACTOR: <br /> v i u 1 <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPERANY INCOMPLETE OR I <br /> . <br /> m <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n. <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) A " <br /> Om <br /> n a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m o A <br /> NORTH(N). <br /> ca 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDINGoS)TO m 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF ) a <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. Z <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. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. v <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: p l <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 SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. t (T <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER y( <br /> SETBACK AREA. <br /> 5. NoCD <br /> r!f 1i1 /1r — c c 6-ytr r1� <br /> 7. -a m c <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my o A <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of w 0 C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize i ` m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- CDsue 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 ve described premises at any reasonable time for the purpose of inspection. <br /> m <br /> m <br /> SIGN HERECD <br /> v W <br /> _ 1C( <br /> (signature of o uilding contractor) (date) (�j <br /> ZONING ADMINISTRATOR )C r <br /> TOWNSHI PERMITS MAY BE REQUIRED <br />