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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -CD o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> N O <br /> N <br /> C <br /> OWNER TELEPHONE /�3o <br /> p `D e� <br /> HOME ADDRESS S CW(�+� AW, tt-)D ? <br /> EMERGENCY/FIRE NUMBER Sy ROAD NAME4 L j hq <br /> LEGAL DESCRIPTION see tax receipt) ' �i Ll v> <br /> m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE / ADDITION ❑ PRIVY V / <br /> TYPE OF PERMIT(S): Q <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ �" <br /> STRUCTURE/ADDITION USE: Q 2 A jF _ S 7—aR 46 L � "7 ' � r;2!�e N <br /> o' <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) rn <br /> m <br /> BUILDING CONTRACTOR: OIAJ►J I m f <br /> m <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> O W <br /> � m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o _ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). y ti 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 Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 9 <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. F <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. a <br /> CONDITIONS OF PERMIT: CN <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT r C <br /> ISSUANCE. C <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. This structure to be used as private residential <br /> X � nrDODOa <br /> 6. garage/storage only. Not to be used for human O M. 3 a 2 o' a s xi <br /> N N — 9 <br /> habitation. y y o : _ =i <br /> 7. o i -n m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G) c A <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of 0 <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize m <br /> CD <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- at7 <br /> sue a permit. er cept all liability which may be a result of the County of Burnett relying on this information I am <br /> providing in his ap i tion. I agree to permit county officials charged with administering county ordinances or other <br /> CD a <br /> authorized p on to a access to the above described premises at any reasonable time for the purpose of inspection. T <br /> m <br /> SIGN HER <br /> (signature of owner or building contractor) (date) ((� <br /> ZONING ADMINISTRATOR �J 1 M l llc7✓1 v ) <br /> TOWNSHIP PERMITS MAY BE REQUIRED gc/ <br />