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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v G) z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> N 0 <br /> N <br /> / N <br /> OWNER T'e jCOP TELEPHONE (OS� �6Z^2 8Z� <br /> _ p1 lN`U <br /> HOME ADDRESS�_ (o]jZ <br /> m <br /> EMERGENCY/FIRE NUMBER / / ROAD NAME <br /> l� <br /> LEGAL DESCRIPTION(see tax receipt) �� C'S/) i /� g y <br /> a <br /> ( o <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ <br /> TYPE OF PERMIT(S): at� <br /> Cr <br /> FILLING/GRADING CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> 5. <br /> STRUCTURE/ADDITION USE: � <br /> T.o <br /> (Home/Cabin; Commercial Busin ; Bedroom; Deck;etc.) N <br /> / m <br /> BUILDING CONTRACTOR: <br /> v <br /> A PLGT�PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> 0 y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p <br /> ....... ..... -n a _CJ <br /> TI 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 <br /> NORTH(N). <br /> 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 <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 1 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 /> b. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 1 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> I O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHENq S <br /> NEEDED. <br /> r--, �A' <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z <br /> CONDITIONS OF PERMIT: P <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. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 6. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,AL�WED �HE REQUIRED W <br /> SETBACK AREA. /�� / G/L`J`C,l� �T/yLJ / I <br /> m �. 3 C <br /> 6 m <br /> G v� mc��no9' 3 <br /> o <br /> N : <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my �j 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 m m ;U <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- p <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 �` 2 <br /> authorized person to hav cess to the above des ribed premises at any reasonable time for the purpose of inspection. d <br /> CD : <br /> �- m : <br /> SIGN HERE <br /> (signatur of o)wtfi or buildin Contra c r) (d te) <br /> ZONING A MI TRATOR GCS L- i <br /> \ to to 0 W w�+ <br /> (y�N N R P P 9 P <br /> (�fT fT O(11 tn <br /> TO NSHIP PERMITS MAY BE REQUIRED 0 0 0 0 Co <br />