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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v 0 Z <br /> APPLICATION FOR LAND USE PERMITS 3 ° <br /> r n- <br /> �" o w <br /> H <br /> c � <br /> OWNER ,s �► S TELEPHONE a Q <br /> HOME ADDRESS v1Fw <br /> EMERGENCY/FIRE NUMBER ROAD NAME v�� w I <br /> I � <br /> LEGAL DESCRIPTION(see tax receipt) I <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ® PRIVY ❑ m <br /> TYPE OF PERMIT(S): ca <br /> c <br /> or <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ 5 <br /> STRUCTURE/ADDITION USE: sTcOmG<!! 6a ?9/7f 1 Uyv Tu GA20&t o <br /> 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) ti <br /> BUILDING CONTRACTOR: 15s L <br /> v t ' <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8Yn X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. yJ <br /> U) (W <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p \ \� <br /> M aJ� Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <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 L 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. 64 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. 5 c <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN 0. o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: ° <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. i <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY Q <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> v 0 r D p,O In <br /> In <br /> 6. 3 'a iiRQoo �c' —ac .� <br /> m C:.0 <br /> o <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my \ 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 A <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to is- 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. 1 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. m <br /> - : <br /> m : <br /> SIGN HERE <br /> (sign a owner or building c tractor) ,, (date) <br /> ZONING ADMINISTRATOR a— r)(�1 2J . . . . <br /> w�»wtn fnw� <br /> NN <br /> (ll con <br /> N V1Ncon <br /> ON <br /> TOWNSHIP PERMITS MAY BE REQUIRED0 0 0 0 0 0 0 <br />