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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 3. <br /> r <br /> y O <br /> N <br /> �-P.�n 7/s-a63-303 7n <br /> OWNER TELEPHONE <br /> HOME ADDRESS <br /> EMERGENCYIFIRE NUMBER ROAD NAM/E� 00 <br /> LEGAL DESCRIPTION(see tax receipt) �la /f'/�C./�S �1a m <br /> O <br /> a: <br /> DWELLING/BUILDING GARAGE/ACC_ ESSDRY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ rn O <br /> TYPE OF PERMIT(S): \f��(I Q ' <br /> FILLING/GRADING 'CAMPING UNIT SUBD I ION ❑ w <br /> STRUCTURE/ADDITION USE: " O <br /> kjaa (Home/Cabin; Commercial Business; Bedro117 Deck;etc.) rn <br /> m <br /> BUILDING CONTRACTOR: [v <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> j N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> nZ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). W 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m a <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. <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 >t 1 <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN q <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: tJ <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. 1C <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY I <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 0 < 3- 00nC <br /> 6. co � onNX –�a — <br /> N C N N O _ <br /> Cl)CD <br /> : '. m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of d C <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize <br /> L . m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- G 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 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. m <br /> m : <br /> CD : <br /> to <br /> SIGN HERE <br /> (signat e o[owneror building contracto (date) <br /> ZONING ADMINISTRATOR f» <br /> cn<n<n Fn Fn w <br /> NO NN NOS <br /> (T O VS OS O O <br /> WNSHIP PERMITS MAY BE REQUIRED 0000000 <br /> 066006 <br />