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-b <br /> Burnett county 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v 0 Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> UT o <br /> m <br /> — r— <br /> OWNE n <br /> TELEPHONE Q o <br /> HOME ADDRESS ' <br /> CD <br /> EMERGENCY/FIRE NUMBER ROAD NAME ' Q <br /> LEGAL DESCRIPTION(see tax recei t] rn <br /> m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSO ST UCTUR EPr 'ADDITION ❑ PRIVY ❑ ,1 (n 0 <br /> TYPE OF PERMIT(S): L"777 Q <br /> FILLING/GRADj�I� CAM ING UNIT SUBDIVISION ❑ <br /> �Y/J N <br /> STRUCTURE/ADDITION USE: o <br /> (Hgme/Cabin; Commercial Business; Bedroom; Deck;etc.) rn = f <br /> p� J't- // m <br /> BUILDING CONTRACTOR: I/ UI'�� 9 <br /> v <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8Yz X 11 SHEET OF PAPER. ANY INCOMPLETE OR El <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> .Zl m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m O <br /> -n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). Cn <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF v <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. o <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. `e <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <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 I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN O <br /> NEEDED. n <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: a <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. I <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY d <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> n D O D f m <br /> 6. m � 3a (OD 0� aCD � <br /> C m `, o' � 3 <br /> 7. Z : <br /> 0 : furl <br /> = �E A <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G) : C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m <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- <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 p <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> -n <br /> N <br /> SIGN HERE F fj —rte (n <br /> I ature o r or building cont rac (date <br /> ZONING ADMINISTRATOR . . . . . . <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />