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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS <br /> r: <br /> '^ 0 <br /> '\ <br /> � 1UJ <br /> h c <br /> OWNER �///D A• �� TELEPHONE <br /> HOME ADDRESS L�L (D O`�U <br /> ! f <br /> ('� �A m <br /> EMERGENCY/FIRE NUMBER �$LIL? <br /> ROAD NAME /J �C <br /> L \ <br /> LEGAL DESCRIPTION (see tax receipt) I � <br /> DWELLING/BUILDING 1:1GARAGE/ACCESSORY STRUCTURE 1:1ADDITION ❑ PRIVY El ® o' <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAM ING UNIT ❑ SUBDIVISION ❑ S � �2� n <br /> STRUCTURE/ADDITION USE: 02 a o <br /> / C ((Homme/Ca�binn;�CCoommercial Busine s; Bedroom; Deck; et . ncn <br /> BUILDING CONTRACTOR: � <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR � <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. n m C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p (D <br /> 'n 0 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T Z <br /> n m �u <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO mo <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 Q <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. 2 o I <br /> F <br /> O 0 &J` <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN � o -�lJ <br /> NEEDED. (� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: o ) <br /> c <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. I )\ <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 /> 5. V F -6or�� � �ld s/ze J J �o <br /> 2 O m a <br /> ( <br /> W N00 <br /> O <br /> o a 211' m <br /> = a : A <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G) c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of n <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m ` m <br /> m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- O <br /> �j <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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> m : <br /> m <br /> SIGN HERE <br /> gnature of a or building contracto y� (date) <br /> ZONING ADMINISTRATOR <br /> TOWN IP PERMITS MAY BE REQUIRED 9 <br />