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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872U Office of Zoning Administrator U 4 <br /> Z <br /> APPLICATION FOR LAND USE PERMITS 3< ° <br /> r 9} <br /> N O <br /> 91s_ C <br /> OWNER TELEPHONE a <br /> ' 3yq-- 51 0 0 <br /> HOME ADDRESS <br /> � 7F <br /> EMERGENCY/FIRE NUMBER a`�o��� ROADNAMEfi.c D <br /> LEGAL DESCRIPTION(see tax receipt) <br /> Cn <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION PRIVY ❑ <br /> TYPE OF PERMIT(S): cn o' <br /> c � <br /> FILLING/G�RA+DING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: <br /> Q(Ho�om, Commercial Business; Bedroom; Deck; etc.) N <br /> d <br /> BUILDING CONTRACTOR: <br /> w <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. T 3 <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING• (AERIAL OR TOP VIEW) 0 <br /> O m <br /> T a <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 BUILDINGSmO A <br /> NORTH(N). C(NB)AND INDICATE 1 �y n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF v <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. z <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 0 <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 <br /> NEEDED. o <br /> n <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. ) <br /> z <br /> CONDITIONS OF PERMIT: o <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 /> 0 9DO aim <br /> (D C y N O j 3 <br /> 7' N N O (O <br /> T <br /> I declare that this application (including any a companying schedule) has been examined by me and to the best of my 1 G) p' O <br /> knowledge and belief it is true, correct and com tete. I acknowledge that I am responsible for the detail and accuracy of J d ? C <br /> all information contained in this application(incl ding any accompan dule)and I further declare that I recognize � m <br /> that this information I am providing will be relied on b the County 7 t7 <br /> P Y tY' i determining whether to is- <br /> sue apermit. I further accept all liability which m be a result of th C� r y ormation I am m <br /> providing in this application. I agree to permit co my officials cha it a i Vr ' ces or other m <br /> authorized pers to have access to the above des !bed premises y reasonable time for e f inspection. <br /> (D <br /> SIGN HERE JUL 2�-1Ua� <br /> (signature of owner or building contractor) URN1-r e) ' <br /> ZONING ADMINISTRATOR CGUNTy <br /> TOWNSHIP PERMITS MAY BE REQUIRED 11U O <br /> a16s S <br />