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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v ci Z <br /> APPLICATION FOR LAND USE PERMITS 3° <br /> < <br /> N O <br /> C <br /> CD <br /> OWNERc�21 ,& TELEPHONE l 3G o w <br /> HOME ADDRESS L '' <br /> 8 � 0CD <br /> EMERGENCY/FIRE NUMBER �_ ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt)2,4 T\ <br /> ( O <br /> O <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION PRIVY ❑ <br /> TYPE OF PERMIT(S): 0 <br /> v <br /> FILLING/GRADING CAMPING UNIT 0 SUBDIVISION Ela <br /> N <br /> STRUCTURE/ADDITION USE: o <br /> l ` —Wo—me/Cabin; Commercial Business; Bedroom; Deck; etc.) y � <br /> BUILDING CONTRACTOR: I Air, <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/: m <br /> X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> O <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) O m <br /> -n n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. <br /> 0 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> M <br /> NORTH(N). C <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 1 <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. <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. <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. c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN m 0 <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 j <br /> ISSUANCE. Q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 1 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY 1 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> s. �� ,oea�I.L to B-�(c P� o� ung ,rLc�m Z� <br /> l 1/nz d� C¢3u/� j- / odd& oC0m <br /> s. 7S fi'7 c er�f� ° l0 3 L a y Q � <br /> cenferIt� -tvWr,�h{h r�a-� Iv` 1'7 , Wei Z C o P 3 <br /> y N O O G <br /> 11 z fns, P : ,� : <br /> =�' : € m <br /> I eclar that t application (including any accompanying schedule) has been exami ed by me and t the best of10 <br /> my �j <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of m Er c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m' m <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 m <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 an easonable time for the purpose of inspection. T <br /> --� / m <br /> SIGN HERE <br /> (signature of own r building contractor) (date) (it' <br /> ZONING ADMINISTRATOR <br /> N P N N <br /> TOWNSHIP PERMITS MAY BE REQUIRED (�j 0 0 0 0� <br /> 000011, <br />