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W&W <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o° o <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> N <br /> C <br /> N <br /> n <br /> OWNER s /n,m TELEPHONE ^p <br /> O <br /> HOME ADDRESS /(�/ 'm <br /> 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME 1 <br /> P <br /> cn <br /> LEGAL DESCRIPTION(see tax receipt) w <br /> I m <br /> 0 <br /> (� o' <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY V' c <br /> TYPE OF PERMIT(S): 2� <br /> FILLING/GRADING CAMPING UNIT ❑1 SI�BVISION s�� <br /> V /Oy o <br /> STRUCTURE/ADDITION USE: <br /> �{�(Hom�e/tCanbin; Commercial Business; Bedroom; Deck; etc.) m <br /> BUILDING CONTRACTOR: —"��/ /r� yL�ix , "" <br /> v <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/]X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n n <br /> m <br /> T � Z <br /> S OR DISTANCES TO BE SHOWN OR DR <br /> 1. ALL REQUIRED DIMENSION TO SCALE. m m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE N o <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO rn �v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF (J� z <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 �. 1 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> o 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN <br /> o <br /> NEEDED. <br /> z 'r <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. P <br /> CONDITIONS OF PERMIT: O <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. / (A <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 /> NG RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> 4. NO STRUCTURES, INCLUDI <br /> SETBACK AREA. $$C <br /> 5' M M.W W 0 M CL :E �- <br /> 3am <br /> m Ox�` - 3 <br /> 6. N y <br /> O <br /> O mC <br /> 7. = U <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G7 C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize (D <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information lam 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. - . <br /> CD : <br /> 6s <br /> SIGN HERE (date) <br /> (signature of owner or building contrac r) <br /> ZONING ADMINISTRATOR / <br /> TOW SHIP PERMITS MAY BE REQUIRED <br />