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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator U 0 o <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r (1 <br /> N 0 JLJ <br /> N <br /> C <br /> tU <br /> OWNER p � ®`y TELEPHONE o p <br /> C <br /> CD <br /> f �y Ogg <br /> �Sr7 <br /> HOME ADDRESS / ��Th S R /r t (i+�. 3 <br /> ` r m <br /> EMERGENCY/FIRE NUMBERROAD NAME 76 v o <br /> �Q y�.r�3 P ys-y �.A <br /> LEGAL DESCRIPTION(see tax receipt) t,ll�O 2 U <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION Lr'J PRIVY ❑ <br /> G N o <br /> TYPE OF PERMIT(S): ' <br /> Q <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ �' M <br /> \ y' <br /> 1 <br /> STRUCTURE/ADDITION USE: CL Lo.s. <br /> (Home/Cabin; Commercial Bu nes% Bedroom; Deck;etc.) U) <br /> BUILDING CONTRACTOR: 5—/ / d' <br /> 1 <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> 0 m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> T <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. f7 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <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 13e' <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 t <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 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. <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. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. Q , <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY bi <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> m ) 0ma � m M. W 0 <br /> 6. COD a2 Faa_ ;0 <br /> !D Cy N o 3 <br /> N O <br /> 7. o m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G) c C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of a B <br /> all information contained in this application(including an accompanyingschedule and I further declare that I recognize ` <br /> pP ( 9 Y ) 9 Q� ° p <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- N' 0 <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 a m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to havq access to the above-described premises at any reasonable time for the purpose of inspection. D <br /> m : <br /> (D <br /> ID <br /> SIGN HERE <br /> igna re of r uilding contractor) (date) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED / / <br />