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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS . <br /> U1 <br /> C <br /> OWNER46 !T TELEPHONE <br /> y m <br /> HOME ADDRESS/�c � <br /> EMERGENCY/FIRE NUMBER (J ROAD NAME //1 y <br /> LEGAL DESCRIPTION(see tax receipt)Sin 4 w r . / 0) <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIW ❑ c o _ <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMP UNIT SUBDIVISI ❑ LS. (b} <br /> STRUCTURE/ADDITION USE: Q�C�/'� �) } - N' <br /> (Home/Cabin; Commercial Bu ' ess; Bedroom; Deck; etc.) m <br /> BUILDING CONTRACTOR: " 4WzL <br /> i <br /> v <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/3 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <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. n m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m :? <br /> NORTH(N). C 0 <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. <br /> S. 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 ) <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> v $ <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c V <br /> CONDITIONS OF PERMIT: 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 /> zvvr 0 a -0 <br /> 6. � mcyFo ' 3 <br /> 7. Z mfD � <br /> o <br /> lam: m <br /> I declare that this application (including any accompanying schedule) has b amined by me and to the best of my �j a p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I e detail and accuracy of n IF <br /> 0 c <br /> all information contained in this application(including any accompanying r ret at l recognize m E <br /> that this information I am providing will be relied upon by the County of B eft i et��[�7J4�rIr�i duhether to is O E E E O <br /> sue a permit. I further accept all liability which may be a result of the C of Burnett relyin o4>tE rmation I am m <br /> providing in this application. I agree to permit county officials charge - h adm�iqq ring county ordina cel or other m <br /> authorized person to have access to a above described premises at a asonalX �[n f t rpose inspection. -n <br /> rCD <br /> SIGN HERE ;�r� SURNEr 1 nom` <br /> (signat-ur�e o(f�'ownerrorr building contractor) pN�NG (date) �s <br /> ZONING ADMINISTRATOR -J 1 m I ICYI 1 <br /> N N (n NNNut <br /> N (7iOCn (n00 <br /> x 0 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 <br /> 0000000 <br />