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v vo ..O <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator L� hoz <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> 0 (1 <br /> ;7o J`J <br /> EDC <br /> tl <br /> OWNER TELEPHONE 7 — C <br /> HOME ADDRESSJ �I d 7 <br /> E o` <br /> EMERGENCY/FIRE NUMBER U1"}^ ROAD NAME �l <br /> LEGAL DESCRIPTION(see tax receipt) <J m <br /> e <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE El ADDITION El PRIVY 1:1 fn 0 <br /> TYPE OF PERMIT(S): / `/ , ' I Q � <br /> FILLING/GRADING CAMPING UNIT E] SUBDIVI ION W7�T <br /> N <br /> STRUCTURE/ADDITION USE: Mb vl-" $ 0 <br /> (Home/Cabin; Commercial Bus i s; Bedroom; Deck;etc.) c <br /> 471, <br /> BUILDING CONTRACTOR: <br /> CDv <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> -n o Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> NORTH(N). fn 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 <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 0 <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 t\a <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS 0 V" <br /> MUST BE SIGNED AND DATED BY THE OWNER. 0 <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. 0 <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT Q ) <br /> lei <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 THS G� RED WATER (f� <br /> SETBACK AREA <br /> l <br /> '0 n d r O m <br /> \/ m <br /> CL CD 6. mCv `" 073 <br /> Z N 0 0 , =j <br /> 7. - 18 P : <br /> =rn : m <br /> 1 declare that this application (including any accompanying schedule) has been ex �F}�y me anWo the est of my C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am respon�* {b o(� etail an curacy of - n E <br /> all information contained in this application(including any accompanying schedule)anAi g1' th t I recognize m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin i termihing whether to is- (�y <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 KJ <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or otherV 3 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. -n <br /> a m <br /> SIGN HE <br /> (signature of owner or bui i on - (date) <br /> ZONING ADMINISTRATOR ' " v ` ` ` to <br /> wwtnE»wvi� <br /> N NN N NUI <br /> (T <br /> On O (!� Crl O P <br /> O <br /> TOWNSHIP ERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br /> 0 0 0 0 0 0 0 <br />