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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 G) z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> N 0 <br /> OWNER �r14P/ D�0e /�� 0'e TELEPHONE 7�.� 7 � , <br /> 9� t m< <br /> HOME ADDRESS 7� 0 <br /> EMERGENCY/FIRE NUMBER ��� ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) SPe �Lr�- _ S�"► l7 Q PNOI y <br /> t m <br /> a <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION PRIVY El m <br /> TYPE OF PERMIT(S): Cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <: <br /> STRUCTURE/ADDITION USE: �� P/Sf��GQ �! = <br /> �� P 1 , <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) U) <br /> m <br /> , T- C� <br /> BUILDING CONTRACTOR: /�!✓l%P/ —� <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMP B. <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) rMJ3 0 o <br /> ev 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. u m W <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). C <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDINGm S)TO 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 <br /> BUILDINGS,ROADS,LAKE,LOT LINES. `r <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> o � t <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN q S r <br /> NEEDED. wW <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: <br /> i <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. t t! <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 /> CD W <br /> 6. �'o � 3 am Ox <br /> CL <br /> � <br /> m C " o 3 <br /> o <br /> 7. z ' N CWD � � <br /> o : <br /> —co: RI <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my L7 c c <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of o <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- O <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 m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> m : <br /> m : <br /> SIGN HEREO G0 <br /> (slg ure o owner b ding contractor) (date) <br /> ZONING ADMINISTRATOR <br /> Cn Cn OCn tn00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED ,� <br />