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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 /> ; r <br /> o <br /> m � <br /> OWNER TELEPHONE <br /> HOME ADDRESS ©Llt1 <br /> NOm <br /> EMERGENCY/FIRE NUMBER A3� ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) pQ o1S — Cn <br /> 0 1 <br /> e YJ <br /> DWELLING/BUILDING GE/ACCESSORY STRUCTURE! ADDITION 0 PRIWI Co 0 (D <br /> TYPE OF PERMITS): i C <br /> ( ) cr <br /> FILLING/GRADI G ❑ CAMPING El DIV SU ION NO �� <br /> STRUCTURE/ADDITION USE: !- <br /> (Home\/Cabin; Commercial Business; Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: <br /> v <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. 0 q) <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a S <br /> 2 0 2 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m a <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE c n <br /> NORTH(N). y 3 <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. P <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. t <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. �n to <br /> ck-j 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q B <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c S�J <br /> CONDITIONS OF PERMIT: <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. V <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQL�RED WATER <br /> SETBACK AREA. <br /> 5. ) 1 <br /> � W <br /> 10 A-(6. -i24 -300�¢� Cv�cQ - n v 3 r ' o v <br /> Y�/b n �. m CL rfDi a m <br /> CD CIO <br /> � N m <br /> I declare that this application (including any accompanying schedule) has been exd by o the be aq c IS <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am respons the det5il/ accura 9T ' m <br /> all information contained in this application(including any accompanying schedule)and I f eclare c lie CD CD m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsi twheth is- O <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett rely) Io lam E m E <br /> providing in this application. I agree to permit county officials charged with administering coun rdi so other m 2 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> CD : <br /> 40 <br /> m <br /> SIGN HERE <br /> (sign t f o er or building contractor) (date) <br /> ZONING ADMINISTRATOR \� <br /> N f�i1 � <br /> P O <br /> TOWNSHIP PERMITS MAY BE REQUIRED o o Q <br /> l? <br />