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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 /> N <br /> CD <br /> I_^ <br /> OWNER TELEPHONE <br /> m <br /> HOME ADDRESS <br /> 79 S one �-�-� 0� <br /> r m <br /> 0 <br /> EMERGENCY/FIRE NUMBER C� ? 9 c3 S ROAD NAME <br /> LEGAL DESCRIPTION see tax receipt) / \ Cn C <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE 1:1ADDITION ElPRIVY ❑ rn 0 ' <br /> TYPE OF PERMIT(S): a _ <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ ....�C <br /> STRUCTURE/ADDITION USE: S! /'E 0 (1 <br /> (Home/Cabin; Commercial Business; Bedroom Deck;etc.) rn <br /> 2.BUILDING CONTRACTOR: / Er <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 /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIE" O m G <br /> In 0. <br /> In 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m z <br /> 2 .SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> NORTH(N). to o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO nl 3 <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. p <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. `L <br /> S. 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 /> q � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VVAY,BE DONE WHEN q <br /> NEEDED. a "V <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: VCR 1,VuC <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS QF��RMIT7-�� y✓ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG�SfHOREf (;QU <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY O/��NG NTy g <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER CY <br /> SETBACK AREA. <br /> 5. <br /> m d o m Q m <br /> 6. 3 CL CD <br /> amCai o9' 3 <br /> 7. Z <br /> y �� <br /> o <br /> = 0): m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G)c ID <br /> knowledge and belief it is true, correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of mLo <br /> all information contained in this application(including any accompanying schedule)and I further declare that Irecognize CD M <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is p <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. I agree to permit county officials charged with administering county ordinances or other (D <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> m : <br /> el <br /> /J m <br /> SIGN HERE <br /> rnr of ow or wilding contract r) (date) <br /> 'G ADMINISTRATOR . . . . . . y, <br /> X4944,m40m4� <br /> N <br /> Cn 0 O 1 0 fn N T U10 <br /> 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />