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° l� <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v 0Z <br /> APPLICATION FOR LAND USE PERMITS 3 p <br /> 0 <br /> ie <br /> N <br /> C <br /> OWNER TELEPHONE <br /> HOME ADDRESS <br /> ��D � ����t✓ %�'bh sso3 ° <br /> Q/1 <br /> x2)o m <br /> EMERGENCY/FIRE NUMBER d O V ROAD NAMES /11 <br /> i <br /> LEGAL DESCRIPTION(see tax receipt) m <br /> cIr n <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION 1:1 PRIVY Elc <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING UNIT pp SU�B,DIVIISION ❑ y, <br /> STRUCTURE/ADDITION USE: �/tb O <br /> (Ho /Ca in; ommercial Bu i ess; Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: O _ CJI E <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 17 SHEET OF PAPER. ANY INCOMPLETE OR n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 H <br /> c C <br /> DIRECTIONS FOR PLOT PLAN DRAWING' (AERIAL OR TOP VIEW) 0 ii <br /> Ts1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C 0 <br /> NORTH(N). (a ° <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m r <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF o <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. W <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. v 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN _q S <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> Q <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. Q1- <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 Q� <br /> 5. <br /> SETBACK AR l <br /> ;a <br /> M W M CL <br /> f��P e �✓AB m <br /> 6. 41 N O y �� 3 <br /> � m Cm <br /> Z 1 <br /> 7. rea �. (�t�rL -r6P ee y- )Fee nm m e)\j a k;;h a>,,5 SrYom L�-0 =N : : i rn <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c i C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of o E' <br /> all information contained in this application(includingan accompanyingschedule and I further declare that I recognize � .. : m : ; m <br /> Y ) g <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- y : O <br /> sue a permit. I fu er tYtiability which may be a result of the County of Burnett relying on this information I am <br /> providing in thi a (cation. I agree to permit c u ty officials a rged with administering county ordinances or other : m <br /> authorized pe o have access to the a e r ed pre at an reason! le tiTe for the purpose of inspection. m <br /> m : <br /> SIGN HER <br /> gna re of owner or b Ilding contractor) (date) <br /> ZONING ADMINISTRATOR <br /> N N ON No 0 <br /> n11/OD N NO Cn N 00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED Iv c <br />