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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 <br /> N O <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> 0 <br /> Q`V �mb TELEPHONE <br /> \ <br /> 71� n <br /> Qt <br /> HOME ADDRESS 2 7& TDAR'(,,AL_k L3g3 <br /> 0 <br /> l p� � sp " W <br /> 7r ar <br /> EMERGENCY/FIRE NUMBER o m <br /> ROAD NAME�Oh� <br /> LEGAL DESCRIPTION(see tax receipt) S. e) 7 PC,) k( (-N CD <br /> DWELLING/BUILDING FVGARAGEIACCESSORY STRUCTURE ADDITION PRIVY 11 rn o <br /> TYPE OF PERMIT(S): Q ' <br /> FILLING/GRADING 1:1 CAMPING UNIT 1:1SUBDIVISION ,❑,1 N <br /> STRUCTURE/ADDITION USE: / + )c. Qx S5, "`�I � ° n 1 <br /> ( e/Cabin' Commercial Business; edroom; Deck;etc.) <br /> jVA) <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> x e <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a <br /> T Z <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 <br /> NORTH(N). y io <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF �' <br /> 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 o <br /> BUILDINGS,ROADS, LAKE, LOT LINES. <br /> S. 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 ,v✓ <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN Cr <br /> NEEDED. 0 f , , <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: �) <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. Cf <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. 6f- <br /> 1(�'C�`" ��/ m � OW 00 ?L m <br /> n <br /> 6. e � a �' m RL ;U <br /> o m C m _ <br /> Z : <br /> 7. P : ;a <br /> M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 3 c c <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of o <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize i m m 7a <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- o0i O <br /> sue a permit. I further accept all liability which may b ¢ %inoguo n this information I am : m <br /> providing in this application. I agree to permit county c ar i myordinances or other mauthorized person to have access to the above describ o 1 i he purpose of inspection. T , <br /> CD : <br /> Q : <br /> cn <br /> SIGN HERE <br /> (signature of caner uildi g tractor + :(date) <br /> ZONING ADMINISTRATOR <br /> ZONING �pLnM0 <br /> N N N N N I T <br /> V• V7 O VI ut O <br /> TOWN41P""ERMITS MAY BE REQUIRED 0 0 0 0 0 0 <br /> �-�yy�e 000000 <br />