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Nq UT <br /> Office of Zoning Administrator o 0 <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 3 <br /> APPLICATION FOR LAND USE PERMITS N <br /> nnn a <br /> TELEPHONE��`�ZS7�66�� o <br /> OWNER a v� <br /> � O <br /> C .� <br /> HOME ADDRESS 2 0 <br /> r P S �^� 0 <br /> EMERGENCY/FIRE NUMBER 3370ROAD NAME ETg1 /' ) <br /> Cn <br /> LEGAL DESCRIPTION(see tax receipt) <br /> 6 U o <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY cr <br /> c C <br /> a <br /> TYPE OF PERMIT(S): �. <br /> FILLING/GRADING ❑ iMPING UNIT ❑;SUBDIVISION y-o' <br /> STRUCTURE/ADDITION USE: O XX l Busmes, Bedroom, Deck, etc) <br /> y ^ <br /> (Home/Cabin; mmerclav I ' <br /> O J <br /> BUILDING CONTRACTOR: " <br /> v <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 30 <br /> _ <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. A y O <br /> O c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) -n v Z <br /> m A <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m C <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE N B <br /> NORTH(N). m p <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO <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. V <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. N <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILL 0 <br /> r y <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS tV <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST pa <br /> BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. Z <br /> 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. I <br /> CONDITIONS OF PERMIT: <br /> I. 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 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. m > o n f m <br /> � <br /> COD 0� <br /> s. o n m <br /> 7. _ U) <br /> application (including ) has been examined by me and to the best of my 2 <br /> I declare that this app g an y accompanying scheduleo <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m v <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> m . <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 <br /> m : <br /> -01 <br /> authorized person to have acce s to the above described premises at any reasonable time for the purpose of inspection. m <br /> r <br /> SIGN HERE (date) <br /> (sign ure o ow r or building contraw) <br /> ZONING ADMINISTRATOR w <br /> TOWNSHIP PERMITS MAY BE REQUIRED N <br />