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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 /> u o <br /> m <br /> a <br /> OWNER TELEPHONE o <br /> m O <br /> CQ s 8 /Ce e al led, --we-A � <br /> HOME ADDRESS h� f <br /> EMERGENCY/FIRE NUMBER ���� / ROAD NAME <br /> 1 <br /> LEGAL DESCRIPTION see tax receipt) N <br /> M <br /> 1 T <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ (� (n <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION <br /> II / IV% /U / / 7 N <br /> STRUCTURE/ADDITION USE: C �i� � 0 <br /> ^� (Home/Cabin; Comm ial Business; Bedroom; Deck etc.) C <br /> BUILDING CONTRACTOR: <br /> Z <br /> v <br /> m <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. p <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> n <br /> ?r a Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m ;b2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> C 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO co 1 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. <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 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. c <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN <br /> NEEDED. ri THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. oCONDITIONS 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. 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 AREA. <br /> 5. <br /> M mr+ maf m <br /> 6. m < a nm OX CD <br /> ID C <br /> fR N O <br /> 7. O : T� m <br /> rn: <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my o' CO <br /> knowledge and belief it is true, correct and complete. i acknowledge that I am responsible for the detail and accuracy of <br /> m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m <br /> CD <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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. n <br /> m <br /> m <br /> SIGN HERE <br /> (signature of owne orb ilding contractor) (date) <br /> Q <br /> ZONING ADMINISTRATOR <br /> TOWNSHI PERMITS MAY BE REQUIRED <br />