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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> TELEPHONipOWNERq7� �V i <br /> Aa <br /> HOME ADDRESS C / / ( �l�C�� " e 3 7 <br /> EMERGENCY/FIRE NUMBER ROAD NAME ` j ~ e <br /> LEGAL DESCRIPTION(see tax receipt) I a���� SyIA <br /> 711 a �I m <br /> ((yy c <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ (�Y <br /> TYPE OF PERMIT(S): V Or <br /> FILLING/GRADING 1:1CAMPING UNIT ❑ SUBDIVISION S. <br /> S. <br /> STRUCTURE/ADDITION USE: �� /� /�/— /�g n <br /> (JHome/Caabiin�;,Commercial <br /> 'Business; <br /> ,Bedroom; eck;etc.) m w <br /> BUILDING CONTRACTOR: ✓"��/►Yi1 v�iC''Y �Yll/I� 6' <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/a X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 m <br /> C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n o. <br /> 2! O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 'A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C <br /> NORTH(N). y o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF W 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 <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• c Ml <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN 4 l <br /> 0 <br /> n <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: <br /> I <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 q <br /> SETBACK AREA. OI <br /> 5. o�0v <br /> L m m <br /> n G CL m F <br /> 6. a N N O <br /> Z <br /> 7. <br /> o rn j [ m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my L7 p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m I <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize �: m <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is. 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 (� <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other �C, m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. T <br /> m : <br /> m : <br /> SIGN HERE <br /> (signature of wrier or building contractor) (date) I1, <br /> I <br /> ZONING ADMINISTRATOR 40���� )En <br /> cNii cNnoUlPPo <br /> 0000000 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />