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ml� C-6 m <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator M ° o <br /> APPLICATION FOR LAND USE PERMITS 3. r- � <br /> o <br /> tll <br /> CD <br /> C (� <br /> OWNER V r TELEPHONE o <br /> m <br /> 3� le�� 9b�-Scw, � e C�4 gsl3S <br /> HOME ADDRESS m <br /> a D <br /> EMERGENCY/FIRE NUMBER ROAD NAME �f1 <br /> LEGAL DESCRIPTION(see tax receipt) fD <br /> C <br /> y o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE—ADDITION— <br /> SANITARY— <br /> TRUCTURE ADDITION SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISIONEr <br /> STRUCTURE/ADDITION USE:� ✓�� "`� < <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) - <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR .n 3 �. <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. x m <br /> C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n M <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 9 z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE c a <br /> NORTH(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 LAKE, ` o <br /> STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 1 <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILD- C!�\ <br /> INGS,ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N I <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS c <br /> MUST BE SIGNED AND DATED BY THE OWNER. n <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE g ° <br /> ISSUED. P<) / r <br /> lam` 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. P <br /> CONDITIONS OF PERMIT: W <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. V ` <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. r <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. <br /> CD <br /> 6. 'per : ry C N y O 7 3 <br /> v y N O O,O <br /> W <br /> O �K : A <br /> 7. = q : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <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 W <br /> providing in this application. I agree to ermit county officials charged with administering county ordinances or other V/: C <br /> authorized person have access to t ove described premises at any reasonable time for the purpose of inspection. m <br /> CD <br /> b - iv - <br /> SIGN HERE A (date) �E <br /> (signature of ow or building contractor) <br /> ZONING ADMINISTRATOR <br /> N N V N N V <br /> f,T O <br /> O 0 0 0 0 0 0 <br /> 0 0 0 0 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 <br />