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1 _ <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator _VG) Z <br /> APPLICATION FOR LAND USE PERMITS 3 < ° <br /> r <br /> OWNER <br /> TELEPHONE <br /> e. O <br /> d <br /> HOME ADDRESS <br /> EMERGENCY/FIRE NUMBER ROAD NAME ft <br /> --T—L <br /> LEGAL DESCRIPTION(see tax receipt) <br /> L 4-u1- is 0) <br /> CD <br /> TYPE OF PERMIT(S): DWELLING/BUILDIN� GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIW ❑ c <br /> y o <br /> c <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SU IVISION u❑ n <br /> � i�—// r�9 .� 1( �y/Q IN lcl� o <br /> STRUCTURE/ADDITION USE: /1r m <br /> (Home/ abin, Commercial Bu a s; Bedroom; eck; etc.) m ' <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 I <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T 3. <br /> 0 y �. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) ;U ti <br /> a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m 9 <br /> NORTH(N). C <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 8 , <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. JU Z <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO o <br /> BUILDINGS,ROADS,LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. ( N r `� <br /> S. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS W <br /> MUST BE SIGNED AND DATED BY THE OWNER. ® � c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN 0 I <br /> NEEDED. Ct c <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 41 <br /> Z b <br /> CONDITIONS OF PERMIT: o `r <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. �j <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY VVVIII"ill I <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER V <br /> SETBACK AREA._�Q v <br /> 5. K.S. Y 18� �1 GLp� <br /> A n r p p 9 <br /> s. m . ' m m <br /> m �aCL "D r-, I <br /> T a i q 'C: =0 S � <br /> Zi y <br /> o : <br /> I declare that this application (including an accompanyingschedule has been examined by me and to the best of my O <br /> PP ( 9 Y ) c <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m C <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- G) m <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this informatio <br /> on 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 ab ve scrib premises at any reasonable time for the purpose of inspection. m <br /> m ' <br /> SIGN HERE - cin <br /> g e of owner or building tor) (date) <br /> ZONING ADMINISTRATOR I <br /> N N V NN NU, <br /> U fT0 (li Ui00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 000000 <br />