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WiTv,;r�,c� <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator �-D c� Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> " � W <br /> N <br /> C <br /> OWNER TELEPHONE <br /> CD <br /> HOME ADDRESS <br /> ed <br /> � n r �nr <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipts WA16 <br /> G ���� m <br /> d <br /> DWELLING/BUILDING 1:1GARAGE/ACCESSORY STRUCTURE ElADDITION ❑ PRIVY [:1o N <br /> TYPE OF PERMIT(S): v <br /> FILLING/GRADING ❑ /CAMPING UNIT '❑/ SUBDIV ION;< <br /> f / n <br /> S. <br /> STRUCTURE/ADDITION USE: CIsh� V �7 /�/ 6 7I N' <br /> 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: Qi(/'/�Q� fit <br /> a <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. n — <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p m <br /> n a <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m �? <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. o <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. <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 /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a <br /> NEEDED. n <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. GAJ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. SLJ <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. y <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER ,VLI <br /> 6 SETBACK AREA. <br /> N M. m m CL m <br /> 6. 0 <br /> N <br /> 7. C O 7P <br /> y� <br /> : r� <br /> N <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m F c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- (� p <br /> sue a permit. 1 further accept all liability which may be a result of the County of Burnett relying on this information I am 4 m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> m : <br /> m <br /> SIGN HERE <br /> (signature owner or building c n rector) (date) <br /> ZONING ADMINISTRATOR ` w <br /> cp ba K)to <br /> N NOT NNPP <br /> V7 (]1 O U7 V7 O O <br /> NSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />