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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator CD- o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> N O0 <br /> w <br /> OWNER /! ` �� TELEPHONE�IS a3f ��_ ^p <br /> r--, W W <br /> HOME ADDRESS $Og q l r/s (fl(=TvS`LiE I r <br /> EMERGENCY/FIRE NUMBER d�I ROAD NAMESpIR-11 L )QKE R , <br /> I <br /> LEGAL DESCRIPTION(see tax receipt) GOU i (PT a SEc. a- ��-i 8 TWP @ F TR Ad ECn <br /> m <br /> DWELLING/BUILDING ❑ LA KL GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ ° <br /> TYPE OF PERMIT(S): Cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ 5 <br /> La <br /> O <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business; Bedroom;Deck; etc.) m <br /> BUILDING CONTRACTOR: S� E <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR In 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 H W <br /> C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) Om a <br /> :2 O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> NORTH(N). 3 <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. P <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. ° <br /> 01 <br /> v � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN CT S <br /> 0 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> I <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 /> 5. mr, MID Q c m <br /> Z : w <br /> 7. P : N E m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G)= : C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of o <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize �� �" m : m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- O O <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. 1 agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to havq access to the above described premises at any reasonable time for the purpose of inspection. -n <br /> m <br /> '/ m : <br /> SIGN HERE <br /> (signature of owner or building contractor) (date) I <br /> ZONING ADMINISTRATOR . <br /> \ 1(Yl � w v+w er<n Fn� <br /> N <br /> (n Nn P [T N0OI <br /> CT [TOO <br /> � O 0 0 0 0 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED �"10 0 0 0 00 0 0 <br />