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owc.4y� <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v 0z <br /> APPLICATION FOR LAND USE PERMITS 3. Ch <br /> N O <br /> OWN�c �/� C � �n TELEPHONE - <br /> 0 <br /> o <br /> m <br /> HOME ADDRESS 26,2c) / 1^1�� r �� �r �I� 111 3' v r <br /> EMERGENCY/FIRE NUMBER a6�Q ROAD NAMEFP <br /> LEGAL DESCRIPTION(see tax receipt) s/� CD <br /> o� /�� e /V/1 3j�Ow� ,3 0)_ <br /> DWELLING/BUILDING ElI�II GARAGE/ACCESSORY STRUCTURE I!'�I ADDITION ❑ PRIVY ❑ l Cn O <br /> TYPE OF PERMIT(S): c r` <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ �' ' <br /> 5. <br /> �-/� N <br /> STRUCTURE/ADDITION USE: Q 5 O <br /> Ho /Cabin; Commercial Business; Bedroom; Deck;etc.) co <br /> BUILDING CONTRACTOR: — tS <br /> v <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 /> XI N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a <br /> 2! z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 'A <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 o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <br /> v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. ° <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 I I <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. f'n <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN Cr <br /> NEEDED. aI Y <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c O� <br /> CONDITIONS OF PERMIT: I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 RAYS 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. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> = dam � L <br /> CL m <br /> 6. CL x <br /> m C H <br /> =rn : m <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my 6 c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of a <br /> all information contained in this application(including an accompanyingschedule and I further declare that I recognize Com <br /> PP ( 9 Y ) 9 m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> sue a permit. I furt7haje <br /> cept all liability which may be a result of the County of Burnett relying on this information I am <br /> providing In this ation. agree to pe o ty officials charged with administering county ordinances or other m <br /> authorized person ac as to the e e ribed premises at any reasonable time for the purpose of inspection. -n <br /> m : <br /> SIGN HERE <br /> (signkfiuretof owner or building contractor) (dat ) <br /> ZONING ADMINISTRATOR ��m ��j).( <br /> N NP(r1 9 O P fly P U1 PP <br /> O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />