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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 /> OWNER TELEPHONE <br /> O <br /> HOME ADDRES <br /> m <br /> S ` ) / (.� �� �5 0 <br /> p <br /> EMERGENCY/FIRE NUMBER 0 ROAD NAME " G�J v `' <br /> LEGAL DESCRIPTION(see tax receipt) v� <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION PRIVY ❑ o 0 — <br /> TYPE OF PERMIT(S): or <br /> FILLING/GRADING ❑ CAMPING UNIT El SUBDIVISION ❑�([/� / 5 <br /> 'ly `') ton �L1�II, evm 11tiC R7 cag n �rC clndy e y <br /> STRUCTURE/ADDITION USE: /��/ r o <br /> ome/Cabin; Commercial Business; Bedroom; ck; c.) m <br /> BUILDING CONTRACTOR: 92 601 } Mur- C pl iS/ /^UC/�jQlj 6; <br /> v <br /> Q <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 (vt1 <br /> i0 y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> m CL <br /> -nZ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m n <br /> NORTH(N). N o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO fn <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. ) 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 ) <br /> MUST BE SIGNED AND DATED BY THE OWNER. o ) <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c W <br /> CONDITIONS OF PERMIT: <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. V1 <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 /> 6. 3 a m x <br /> W C: N y o <br /> 7. Z : <br /> m N K <br /> O ZM <br /> Cl): .G <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my p <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of o <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize m (D m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- ()/ m 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 m <br /> providing in this application. 1 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. m <br /> t .Z2 m <br /> SIGN HERE /� <br /> (sl tur owneror uildi ontractor) (date) <br /> ZONING ADMINISTRATOR ` <br /> N wwwwcnv.� <br /> 1Y N NI71NNfT (n <br /> (P (P 0111 tT00 <br /> TOWNSHIP PERMITS MA BE REQUIRED Z <br /> 0000000 <br />