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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o o <br /> ` APPLICATION FOR LAND USE PERMITS T <br /> r: r0.� Q-� <br /> N (^v W <br /> \ <br /> OWNER AJ f ^A O TELEPHONE >— <br /> _ a <br /> HOME ADDRESS <br /> ✓t UCJ !� a <br /> EMERGENCY/FIRE NUMBER \(/ ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) W <br /> Q Cn <br /> M <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION Q = <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT <br /> SUBDIVISION oCn ' <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) '� 1 <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 3 <br /> O �- <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) ; <br /> c <br /> O a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. TZ <br /> a <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS (EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <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 LAKE, 'R <br /> 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 BUILD- <br /> INGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. �G'N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE PLANS C <br /> MUST BE SIGNED AND DATED BY THE OWNER. 0 �• o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 0 QJ <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P <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 SHORELIN <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFI AtL �� p <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,A I 1F�TI�H1E li-+ <br /> PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. WM OF LAKES, <br /> t� <br /> 5. r] p <br /> 6. ,VN L 7 1�b `° <° °�' � 0 CQF m <br /> n < n o a <br /> CD � n.m �c _ ;a <br /> CD C N N O <br /> 7. ER CpUN Z y � <br /> P <br /> I declare that this application (including an accom an m schedule s been a by me and to the best of my 6 <br /> PP ( 9 Y P Y� a ) n A <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 CL <br /> m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m p <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 applicatio I agree to permit county officials charged with administering county rclinanc or other <br /> : <br /> authorized person to hav cess to the a described remises at any reasonable time for the p rpose <br /> o nspection. Om <br /> CD <br /> CD <br /> SIGN HERE <br /> (sig MOT owner or building contractor) (date) <br /> ZONING ADMINISTRATOR <br /> ITD✓Yl.ei (NT N O N ,(Nli O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 3uue✓ o 0 0 0 0 0 0 <br />