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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> tlJ � <br /> N <br /> C <br /> 0 <br /> OWNERSJ,.. � TELEPHONE <br /> O <br /> d (�, <br /> HOME ADDRESSV �\J <br /> r 9 <br /> 0 <br /> EMERGENCY/FIRE NUMBER L3 ROAD NAM <br /> LEGAL DESCRIPTION(see tax receipt) �LJ I C <br /> CD <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY 1:10 <br /> e <br /> TYPE OF PERMIT(S): N <br /> c � <br /> FILLING/G MWN ❑ CAMPING UNIT ❑ SUBDIVISION ❑ 5 <br /> N <br /> STRUCTURE/ADDITION U 0 <br /> ( /C in; Com rcial Bu iness; Be om; Deck;etc. ur <br /> BUILDING CONTRALTO i3 <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. p <br /> :0 H <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> _n oz <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE c n <br /> NORTH(N). N 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO rn v <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. C�QN <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. ,o o <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN W CEJ <br /> NEEDED. rim <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o tl <br /> CONDITIONS OF PERMIT: •7✓ <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 /> 5This structure to be used as private residential rn v M. d r. o o m <br /> garage/storage only. Not to be used for human m B n - z <br /> habitation. a m c N !^ g s 3 <br /> C'): ' m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my tj c c <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> CL <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize CD CD <br /> O <br /> m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- �` m <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. Iree to It co ty officials charged with administering county ordinances or other m <br /> authorized person to have access the bo des ibed pr ises at any reasonable time for the purpose of inspection. m <br /> CD : <br /> cc <br /> SIGN RQE <br /> L� A <br /> (sig ature of o er or bu mg contractor) (date) <br /> � V4 <br /> ZONING ADMINISTRATOR 1 / . . . . . �+ <br /> N NCn N NCM Cn <br /> fn fnOCM VtOo <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 0 0 0 0 0 <br /> 0000000 <br />