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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o c <br /> APPLICATION FOR LAND USE PERMITS <br /> H <br /> CD <br /> �/ <br /> TELEPHONE �1s-&4&- ��O v <br /> OWNER C <br /> n `'� t p� <br /> HOME ADDRESS / `J�/jyJ � Qy/e g� fA)� <br /> EMERGENCY/FIRE NUMBER Lr ROAD NAME ��� r) <br /> LEGAL DESCRIPTION(see tax receipt) J(� . <br /> ❑ "U 0 <br /> DWELLING/BUILDING W GARAGE/ACCESSORY STRUCTURE ❑ ADDITION PRIVY 1 c <br /> o <br /> o- <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ H <br /> STRUCTURE/ADDITION USE: 1)'0 C L� <br /> (Home/Cabin;Commercial Business, Bedroom, Deck,etc.) JQ <br /> ,I� m <br /> BUILDING CONTRACTOR: <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR _n <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. x N V <br /> c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n o. <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. rn °' <br /> m V <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C V� o <br /> NORTH(N). N ("fit <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 �I o <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 2 �Q <br /> MUST BE SIGNED AND DATED BY THE OWNER. v 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN g S w <br /> NEEDED. 0 <br /> z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. ° <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT t <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 /> ING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> 4. NO STRUCTURES, INCLUDING RETAIN <br /> SETBACK AREA. <br /> 0 CL <br /> rr CL 0 X <br /> 6. <br /> m C mO . <br /> N N : : <br /> N <br /> Q <br /> O � i i M <br /> 7. =moi : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of in6, C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of t f � <br /> all information contained in this application(including any mpanying schedule)and I further declare that I recognize : m <br /> �1 ; : ci : v <br /> that this information I am providing will be relied upon by f Burnett Wisconsin in determining whether to is- : m : <br /> sue a permit. I further accept all liability which may be f f Burnett relying on this information I am <br /> providing in this application. I agree to permit cou fficia t staring county ordinances or other m E <br /> authorized person to have access to the above desc d premises a a a kine for the purpose of inspection. - <br /> M :: <br /> Ay .� o2000 <br /> SIGN HERE ' (date) <br /> (si ur of owner or 8 r) <br /> ZONING ADMINISTRATOR <br /> G N N(7 N N (T N <br /> ut utOUt VtOO <br /> O0 0 0 0 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />