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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Admi�or m o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> N <br /> C <br /> OWNER TELEPHONE c <br /> HOME ADDRESS 0 <br /> CD <br /> EMERGENCY/FIRE NUMBER A NAME <br /> LEGAL DESCRIPTION(see tax receipt) 1IT 3 O � 7q-apjCn <br /> 0. <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTUREADDITION ❑ PRIW ❑ ) CO C <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING UNIT 1:1 SUBDIVISION El 5.5. <br /> STRUCTURE/ADDITION USE: e 0 <br /> o e/Cabin; ommercial Business; Bedroom; Deck; etc.) m <br /> BUILDING CONTRACTOR: CID <br /> v <br /> A PLOT PLAN MUST BE PROVIDED O EAST AN 8Y:X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> O <br /> � � O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> -n O 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 C n <br /> NORTH(N). y 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. I N <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. o <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHENa 0 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> I <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 /> zv �do�ov <br /> 6. 30.cp Ix 3 <br /> N C N . <br /> Z : N <br /> 7. 0 : il'< <br /> = cn : <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of \' c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m M <br /> M <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- a <br /> sue a permit. I further accept all liability which may b resu the County of Burnett relying on this information I am m <br /> providing in this appy' n. I agree permit c y o 1al charged with administering county ordinances or other m <br /> authorized person have a ess to ab rib pre sea at any reasonable time for the purpose of inspection. T <br /> M : <br /> 2 _ m <br /> SIGN HERE <br /> (signature of owner or building contractor) (date) <br /> ZONING AD INISTR OR \o //YI C150 �+ <br /> N <br /> N <br /> J 113b N (n NEn to <br /> / ro ro O N) (TOLn <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br /> 0000000 <br />