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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v c) Z <br /> APPLICATION FOR LAND USE PERMITS 3° <br /> UT 0 <br /> N <br /> C <br /> OWNER TELEPHONE <br /> J o <br /> HOME ADDRESS O <br /> cam— �LLJ ✓ /! / <br /> 0 N <br /> 0 <br /> EMERGENCY/FIRE NUMBER / ROAD NAME <br /> �l� - � <br /> LEGAL DESCRIPTION(see tax receipt) 6 � <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ ' o <br /> TYPE OF PERMIT(S): 1 � � <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ �' �: <br /> Garage_ <br /> STRUCTURE/ADDITION USE: a� K <br /> 3 Vo <br /> o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) ti <br /> BUILDING CONTRACTOR: / / V <br /> �T 42 1 <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/z X 11 SHEET OF PAPER. ANY INCOMPLETE OR � <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> n n <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m CD <br /> NORTH(N). c n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 33 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS I <br /> MUST BE SIGNED AND DATED BY THE OWNER. S -i <br /> ° F V� <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <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. X _U <br /> M. 0 00a *E <br /> M m o m n m <br /> 6. m << 3 a m 0 n <br /> a m C N N o 3 <br /> 7. ymo <br /> Z <br /> 7i A <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my w a c <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of 0 m <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 <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 C <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have ac ass to the above described premises at any reasonable time for the purpose of inspection. m <br /> m <br /> CD <br /> SIGN HERE �� d <br /> (signature of o er building contractor) (date) <br /> ZONING ADMINISTRA R v I 9j <br /> TOWNS IP PERMITS MAY BE REQUIRED <br />