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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o" o <br /> APPLICATION FOR LAND USE PERMITS 3. c` , <br /> .. r � 'j <br /> N <br /> OWNER ,.�. rSd�� TELEPHONE 7/ �J3S— <br /> m <br /> HOME ADDRESS <br /> o <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) 0 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ <) m <br /> o <br /> TYPE OF PERMIT(S): a 0 <br /> c <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION a <br /> STRUCTURE/ADDITION USE: Cs/7-) V, I / <br /> (Home/Cabin; Commerl5ial Business; Bedroom; Deck;etc.) rn <br /> BUILDING CONTRACTOR: 'S116 le klS L-L2 L/7 -7 Cl <br /> T <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 3' 4 <br /> N C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> M 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 /> n <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. P <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. IV <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS �jl <br /> jG <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 WHEN I� <br /> NEEDED. 0 oma' <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> 0 <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. W <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> ;a -V � g L <br /> 0 <br /> 6. <br /> (Dc07. . <br /> o : <br /> l o): m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c3 c ID <br /> C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of (S o g <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognizem m m <br /> �lE <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- E O <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 ivd <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> P 9 PP� 9 P tY 9 9 tY <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. T <br /> m : <br /> m : <br /> SIGN HERE <br /> (signs re of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR fn <br /> N N 01 N N 01 (T <br /> (T IT 001(TOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />