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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 3. <br /> UT o <br /> OWNER/ j� TELEPHONE 71�,j8/ vZ <br /> HOME ADDRESS � <br /> r � <br /> c 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> I <br /> LEGAL DESCRIPTION(see tax receipt) .23T(�91 A 1 7J 0 <br /> /�V _ o <br /> TYPE OF PERMIT(S): <br /> DWELLING/BUILDING GARAGE/ACCESSORY STR CTURE ❑ ADDITION ❑ PRIVY ❑ N <br /> ii <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ C` <br /> m' <br /> STRUCTURE/ADDITION USE: liN 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) ur <br /> m <br /> BUILDING CONTRACTOR: G <br /> � 1 <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T a <br /> o Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m n <br /> NORTH(N). 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDINGmS)TO ra � <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. 1 <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <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 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a o <br /> NEEDED. 0 <br /> F Z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <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 1 <br /> PERMITTED. It <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQ�TER Q S <br /> SETBACK AREA. fte , <br /> 6.6. STGLe �Ilt ( �')� ' b / J m N � nnam V . 3 am �cQ= � <br /> 7. AY o ` N `° -I <br /> OfAn. - � . M <br /> I declare that this application (including any accompanying s has been ex ed b me and to the best of my cj c ID <br /> knowledge and belief it is true,correct and complete. I acknowle �p`o.nsible f e detail and accuracy of �j M <br /> CL <br /> all information contained in this application(including any accompanyppy�����h `�'[I/ u er declare that I recognize m m <br /> �`ISNI c Asi ' m <br /> that this information I am providing will be relied upon by the County o i <br /> In <br /> n In determining whether to is- O <br /> sue a permit. I further accept all liability which may be a result of the County o urnett relying on this information I am <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to haV access to a above 40scribed premises at any reasonable time for the purpose of inspection. -n E <br /> M :: <br /> f m <br /> SIGN HERE ` ' <br /> (signature of n or bu g ac (date) <br /> ZONING ADMINISTRATORztl <br /> <n En�»fn fn cn <br /> N NNNNfT U1 <br /> fly f11 O N Vt 0 0 <br /> TO NSHIP PERMITS MAY BE REQUIRED 0C> <br /> 0 0 0 0 <br />