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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - a o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> _ 1r .v1 <br /> N <br /> OWNERV d �� TELEPHONE <br /> �— m •\' <br /> HOME ADDRESS <br /> r fT1 � <br /> EMERGENCY/FIRE NUMBER 8 S Cr ROAD NAME 1`1 <br /> LEGAL DESCRIPTION(see tax receipt) y <br /> C <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ ( N <br /> TYPE OF PERMIT(S): Cr <br /> FILLING/G DING ❑ AM PI UNIT ❑ SUBDIVIS N ❑ <br /> N <br /> STRUCTURE/ADD0ITION USE: W � � � � <br /> c I me/Cabi Commercial Business; B U <br /> oom; Deck;etc.) <br /> BUILDING CONTRACTOR: C e <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR n 33 <br /> — <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. ) I '_ O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) �m I�'T I i n a <br /> G �+ v z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. VV ' O y W z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m n <br /> NORTH(N). y <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 I z <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 O <br /> 30 <br /> BUILDINGS,ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 1 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. ' <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN ° <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o I <br /> CONDITIONS OF PERMIT: () C <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT �Y <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. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> (D M 0 (D rn <br /> 6. m3 nm Jnr .O <br /> 9 m C=W, <br /> Z � q -1 <br /> 7. P m. : M <br /> M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Lj c C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy ofn E' <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m 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 accept all liability which may be a result of the 9 WIRV Me =nances <br /> this information i am m <br /> providing in this application. I agree to permit county officials charge ad or otherauthorized p rson to have access to the above described premises at aa of inspection. T <br /> CD : <br /> CD : <br /> SIGN HER <br /> 26a <br /> (signat re o wner or bull ing contra r) d_ate) <br /> f r v: <br /> ZONING ADMINISTRATOR :JI'm 1�lafl1qc-h1 3URNETTCOUNTY ZONING N N N o <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 0 <br />