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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 G z <br /> APPLICATION FOR LAND USE PERMITS . <br /> r <br /> o <br /> m <br /> + ) Z c <br /> OWNER TELEPHONE <br /> ��A�� TELEPHONE <br /> HOME ADDRESS <br /> t" r <br /> EMERGENCY/FIRE NUMBER � ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) E ` �� OV(n /2 L <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ Ci N <br /> TYPE OF PERMIT(S): Q <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ !, C s n <br /> STRUCTURE/ADDITION USE: �+� Xx 0 <br /> ome/ abin, Commercial Business; Bedroom; Deck,etc.) v <br /> � / m <br /> BUILDING CONTRACTOR: /V.0 7-1-1 fIuin_HO rcJCTs ` <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> O <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o C <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). 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. 1 \t 9 <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO <br /> O <br /> BUILDINGS,ROADS,LAKE, LOT LINES. <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. I N <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. ,o o .0 <br /> o � � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERT NE WHEN ° <br /> NEEDED. moi, <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. �1] /,' o N C <br /> CONDITIONS OF PERMIT: <br /> ?4c2004 o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS O�IT k <br /> ISSUANCE. -"rVE7'r Cp <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELI t, COV Ul <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY �ING ,Y" <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> CD 0 CD n o M <br /> 6. 0 < 3a2OxnmA <br /> (D C y N O <br /> N CD O O <br /> 7. O Z1 <br /> = rn : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 0 2 C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of @CL <br /> all information contained in this application(including an accompanyingschedule and I further declare that I recognize ` <br /> PP ( 9 Y ) 9 `D CD p <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 am <br /> providing in this application. 1 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. -n <br /> m <br /> m <br /> SIGN HERE <br /> (signature of owner or building ontractorI (date) <br /> ZONING ADMINISTRATOR 0 <br /> �q a,UZ toq ��� O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 1 <br />