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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> — r <br /> UT O <br /> N ` n <br /> C v\ <br /> OWNER f nis0 yt TELEPHONE a <br /> m <br /> (D O <br /> HOME ADDRESS /� f� �� Qlt <br /> 3D o <br /> EMERGENCY/FIRE NUMBER '�� � ROAD NAME <br /> L 3 CSry, ✓l /a �! J <br /> LEGAL DESCRIPTION(see tax receipt) I U)m <br /> DWELLING/BUILDING LTJ GARAGE/ACCESSORY STRUCTURE El ADDITION ❑ PRIVY ❑ �J\ 0 <br /> TYPE OF PERMIT(S): 1 <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISIONo <br /> ❑ r� n <br /> \.Y y <br /> STRUCTURE/ADDITION USE: 1'I6� -e 1 <br /> Home/Cabin; Commercial Business; Bedroom; Deck;etc.) U) <br /> BUILDING CONTRACTOR: ���• f✓ /tom-��-� 42° <br /> v <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> T <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). CD <br /> ° <br /> M o <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 Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. I <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. �J N <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. P <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS I 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o ° <br /> C v S� <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN ° ) <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. 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. Ll <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. <br /> 5. A -V n D O D v v <br /> CD m = c°i CD Ox m <br /> `° <br /> 6. Q N N O N j 0 <br /> O m� <br /> 7. -. <br /> - 0 : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Gc <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of Q , <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize Q : CD <br /> that this information I am providing will be relied upon by t o urnett Wisconsin in determining whether to is- �j <br /> sue a permit. I further accept all liability which may be a re o e relying on this information I am ° <br /> providing in this application. I agree to permit county offi d d i r u ordinances or other <br /> authorized person to have access to the above described pr ses a a I urpose of inspection. m ° <br /> CD <br /> (D <br /> SIGN HERE <br /> JUN <br /> gn re of ne r building contractor) (date) <br /> ZONING ADMINISTRATOR �l/!� BURNE <br /> ZONING <br /> TOWNSHIP PERMITS MAY BE REQUIRED Co <br />