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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 /> 0 cv` , <br /> m N <br /> c <br /> OWN ER M�� TELEPHONE <br /> ww <br /> HOME ADDRESS �L v <br /> EMERGENCY/FIRE NUMBER ROAD N MEF;w-r:w� ,f2.� <br /> -z7oc> ) 1� ' <br /> LEGAL DESCRIPTION (see tax receipt) Ald L. � v , <br /> DWELLING/BUILDING;2- GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ , N 0 <br /> TYPE OF PERMIT S)' a <br /> Cr <br /> FILLING/GRADING El CAMPING UNIT^❑ SUBDIVISION Ela <br /> STRUCTURE/ADDITION USE: NSG '�C 7 �J o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) y <br /> BUILDING CONTRACTOR: -, <br /> Q <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. �• <br /> O <br /> x <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O c <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 1D <br /> NORTH(N). CO) o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <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. 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 /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a ° <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. of <br /> CONDITIONS OF PERMIT: <br /> 1 <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 1i <br /> PERMITTED. f'� <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> 5. TB KAREA. �ZJV�L�_, e / o� r <br /> �O ��-7/ (l�(f°"'� '/Luro6�'� •vL0 {C�11iL//2 z v o o O <br /> y <br /> " 0, 3 <br /> 7. <br /> R N O OIC =io <br /> Z : ill< <br /> =rn `• i i m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c O <br /> knowledge and belief it is true, correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of Vi m m C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize ^�: . A <br /> m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- i v <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information I am 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 41fRE <br /> (signature o ero I ' o r tor) J� (dat <br /> ZONING A I T T <br /> tnwwEnEnw� <br /> N NO� NN <br /> (T N O N PO <br /> N O O <br /> T WNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />