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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 �tv <br /> Office of Zoning Administrator 0 o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> / 1 N <br /> OWNER TELEPHONE <br /> r VI <br /> In 9Dl C � 17" c� 571 ° <br /> HOME ADDRESS F <br /> EMERGENCY/FIRE NUMBER / �Q� ROAD NAME zi/`L// <br /> I <br /> LEGAL DESCRIPTION(see tax receipt) <br /> CD <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE I� ADDITION ❑ PRIVY ❑ O o' <br /> TYPE OF PERMIT(S): N <br /> U <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: N <br /> o' <br /> (Home/Ca n; Commercial Business; Bedroom; Deck, etc.) rn O <br /> BUILDING CONTRACTOR: AAA LAW SO tt� 2 /��S/�G/�1� e��/�![✓ <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/z X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 r <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n _. VCU <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> m <br /> n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m D <br /> NORTH(N). <br /> 0 <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 \ Z <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. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 0 Cap <br /> MUST BE SIGNED AND DATED BY THE OWNER. o ) <br /> v 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN T °, <br /> NEEDED. Q <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1 <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 /> 5. WB <br /> ACK AREA. <br /> XUV _ <br /> CD M. W 0 CD CL D V D f m <br /> CD C: � <br /> N C N y O j 3 <br /> 7. y O O <br /> O T1 Z1 <br /> M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my A <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of \ m 0 m <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize O <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <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 application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. rD <br /> m <br /> CD : <br /> SIGN HERE <br /> (signatur f owner wilding contractor) (date) (� <br /> ZONING ADMINISTRATOR c v I <br /> TOWNSHIP EIRMITS MAY BE REQUIRED <br />