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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -U o <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> Du <br /> � / <br /> OWNER �1�d /✓/O/�� r TELEPHONE Lz u� <br /> HOME ADDRESS /—TO/ CDyQF le e_` —(Ad �j O� <br /> EMERGENCY/FIRE NUMBER '� /� ✓ ROAD NAMEv l <br /> -/ ' e > <br /> LEGAL DESCRIPTION (see tax receipt) /1U N tj cl- � <br /> DWELLING/BUILDINGX GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ N o_ <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: 36 <br /> o <br /> (Home/Cabin; COm ercial,Busipess; Bedr ; Deck; etc.) W ' <br /> BUILDING CONTRACTOR: p(l( Ol`iJ(J <br /> d <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. <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) <br /> O m <br /> -n o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE, n o Z QS <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m � X <br /> NORTH(N). a 0' <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 0 r� <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. (n Z <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO "() o <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 N <br /> 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. 1 ' <br /> o Q <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN o _^ <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z �O <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. V� I <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 REA. <br /> 5. <br /> 6. m -Uvo >° av � <br /> CO 3 nm x °'m <br /> 'O N C N �' O 3 <br /> 7. Z in (Do <br /> o Tom : m <br /> I declare that this application (including an accom an m schedule has been examined by me and to the best of my G)2 A <br /> PP ( 9 Y P Y 9 ) <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m 0 m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize <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. 1 further accept all liability which may be a result of the County of Burnett relying on this information I am <br /> m . <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> m <br /> ID <br /> SIGN HERE <br /> (signatu o r or building contr for (date) J <br /> ZONING ADMINISTRATOR <br /> NSHIP PERMITS MAY BE REQUIRED <br />