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Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator -V 0 z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> 0 <br /> V, O <br /> 41 <br /> TELEPHONE C <br /> HOME ADDRESS PO ��� ��� �e v �J 0 <br /> EMERGENCY/FIRE NUMBERROAD NAME <br /> _10 g <br /> 4 <br /> LEGAL DESCRIPTION(see tax receipt) rn <br /> I � <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ m <br /> TYPE OF PERMIT(S): pC <br /> CA Cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ J<-�`"��� ���L a <br /> T. <br /> H <br /> STRUCTURE/ADDITION USE: �o? 0 <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) co <br /> BUILDING CONTRACTOR: <br /> v � <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. 0 ( (� <br /> O W <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O C V/ <br /> � a <br /> -n z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m ',p <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m \ 3 <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. O <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N r� <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS 1 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. �� 0 1 <br /> o W W, <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. Cr SCJ <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 (� <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 6. <br /> 7. <br /> zi �Q i 10 <br /> =co <br /> I declare that this application (including any accompanying schedule) has been a fined b m a9d to the b y c ID <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am res or the clet }} d acc cy of m c <br /> all information contained in this application(including any accompanying schedule)an I decla gaget nize m m . <br /> that this information I am providing will be relied upon by the County of BurnettWiscon �[�p ning wo is- osue a permit. 1 further accept all liability which may be a result of the County of Burnett re t� IamVj <br /> providing in this application. I agree to permit county officials charged with administering cour q ordi therCD <br /> o <br /> authorized person to hqye access to the above described pleni#as at any reasonable time for the purpose of inspection T <br /> m : <br /> 169 <br /> m : <br /> SIGN HERE J <br /> (signatur of er or building con r) (date) <br /> ZONING ADMINISTRATOR <br /> w fnwv+wfn <br /> NNNNIT VI <br /> N NOutNOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED °0 0 0 0 0 <br />