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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - 0 0 <br /> APPLICATION FOR LAND USE PERMITS - <br /> �( <br /> III <br /> eON OWNER Wl PH <br /> HOME ADDRESS m <br /> EMERGENCY/FIRE NUMBER ROAD NAME ° <br /> LEGAL DESCRIPTION(see tax receipt) 4 L Oti O?(/ -23-9— <br /> rn ° <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY D � o <br /> or <br /> TYPE OF PERMIT(S): <br /> a <br /> PILLING/GRADING ❑ CAMPING UNIT SUBDIVISION ❑ _ /(' c-�,,. / 0. M ^ <br /> STRUCTURE/ADDITION USE: , <br /> (Ho a/Cabin; Commercial Business; B droom;Deck; etc.) m <br /> m <br /> BUILDING CONTRACTOR: .Z <br /> 0 <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 Q p _ <br /> �1 N W <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) <br /> O o <br /> 'T <br /> ?1 o Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 W � <br /> m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m o <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 v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF O <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. 0 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR,ETC.,THE PLANS ?, i <br /> o <br /> MUST BE SIGNED AND DATED BY THE OWNER. t7 <br /> ° I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN —, <br /> NEEDED. <br /> Z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. ° <br /> CONDITIONS OF PERMIT: d <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. W <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 /> SEACKAREA. <br /> 5. ,�'y'1J z 0 >a > 0 'D <br /> � � 3 nCD CL M <br /> yam <br /> 6. 'O N N N N O <br /> Z O . <br /> O -n m <br /> 7. _ � 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 /> o <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of c <br /> 35 <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize (n. m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- "1 G <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. - . <br /> ` , II m <br /> 0-Kvr W/ I <br /> SIGN HERE ^ / <br /> (signature of or budding contractor) (date) <br /> ZONING ADMINISTRATOR / <br /> TOW SHIP PERMITS MAY BE REQUIRED <br />