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6&'J46 <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 0Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> OWNER TELEPHONE Y� S( / <br /> m <br /> HOME ADDRESS <br /> 76? 7 0 <br /> EMERGENCY/FIRE NUMBER cin o ROAD NAME ) <br /> LEGAL DESCRIPTION(see tax receipt) L tel— p� I N <br /> m <br /> c <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ c G <br /> TYPE OF PERMIT(S): Cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION E` <br /> La <br /> STRUCTURE/ADDITION USE: C 0 <br /> (Home/Cabin; Commercial Business; edroom; Deck;et m <br /> BUILDING CONTRACTOR: <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p — <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 0) 'u <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C <br /> NORTH(N). to 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 <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. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS xJ <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN <br /> NEEDED. Ll <br /> 7-+ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o U 1 <br /> CONDITIONS OF PERMIT: b <br /> d � <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 /> SETBACK AREA. <br /> 5. <br /> M = 0 911 �Cm <br /> d <br /> 6. m 6< 3 o.m RL � <br /> OLD. <br /> 'CD CO3 o � 3 <br /> 7. Z �� <br /> O <br /> _ ti : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of (j c c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- �: O <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 m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other 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 /> Q : <br /> SIGN HERE <br /> (signature wrier or building cont ctor) (date) <br /> ZONING ADMINISTRATOR d' <br /> t»to v+to <br /> VI <br /> Nn P N N(n <br /> S41 O 01 Cn O <br /> T WNSHIP PERMITS MAY BE REQUIRED o 0 o o 0 <br /> 00000 <br />