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- G <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> ^� r <br /> y O <br /> N <br /> C <br /> OWNER ii <br /> ll / TELEPHONE <br /> C� t �4/ ��2�✓ll l/LY <br /> HOME ADDRESS Ot <br /> EMERGENCY/FIRE NUMBER ROAD NAME le ( ^ <br /> LEGAL DESCRIPTION(see tax receipt) �T l S— C�(� / / m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY o <br /> TYPE OF PERMIT(S): ❑ C { <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION a \V <br /> N <br /> STRUCTURE/ADDITION USE: r ��`] �9 0' <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) y <br /> m <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m 3 C <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) � ii <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m 9 <br /> NORTH(N). <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 Z <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. <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 IT <br /> MUST BE SIGNED AND DATED BY THE OWNER. m c <br /> v <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. <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. +n <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. l <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER W <br /> SETBACK AREA. {` <br /> 5. tS <br /> nO. 0 al m <br /> 6. mC"aG <br /> 0o <br /> @ N O O a] ¢ <br /> 7. C : <br /> y : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Zj c p <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize (D m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- i io <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 ; <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 above described premises at any reasonable time for the purpose of inspection. r E E <br /> m : <br /> m : <br /> SIGN HERE <br /> ("nature of owner or b i ding contractor) (date) ( • <br /> ZONING ADMINISTRATOR <br /> ra f�71 N N N ul <br /> V7 N ON CI100 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />