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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> y O <br /> N <br /> OWNERCYX"� TELEPHONE <br /> m <br /> / <br /> HOME ADDRESO <br /> S � � — � rC— I <br /> r <br /> 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME 1 <br /> LEGAL DESCRIPTION(see tax receipt) PC G / a� _ —/� I m <br /> c <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ o 0 <br /> TYPE OF PERMIT(S): a <br /> Cr <br /> FILLING/GRADING ❑ CAMPING UNIT <br /> ❑ SUBDIVISION <br /> STRUCTURE/ADDITION USE: o; <br /> CS V. /�7-/� 8 y <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; jetc.) y <br /> BUILDING CONTRACTOR: <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. n <br /> O <br /> �I in <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m 'o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). y o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO rn 3 <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. <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. Q <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <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. c YJ <br /> v � I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN Cr <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P <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. <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. <br /> X -0 n r v OF -0 <br /> 6. CLCD ratd .'0 <br /> N C W . O 7 3 <br /> 7. z : �^ m � : � ° � <br /> o : <br /> y : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my �j c p <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of S o S <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize 1ti m m . . . <br /> that this information I am providing will be relied upon by the County of Burneft Wisconsin in determining whether to is- O 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 �: 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 any reasonable time for the purpose of inspection. m <br /> m : <br /> CD : <br /> SIGN HERE rr,, <br /> (signat a of owner or buildi c ntractor) (date) W <br /> I <br /> ZONING ADMINISTRATOR • • • • . . fn <br /> f»wwwwcn� <br /> N N ut N N Vt Ut <br /> ut V1 0 01 01 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> 0000000 <br />