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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m o c <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> N <br /> C <br /> _ N <br /> OWNER / TELEPHONE <br /> � d <br /> HOME ADDRESS a gAle- <br /> r <br /> 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME 1 <br /> LEGAL DESCRIPTION(see tax receipt) L LV > P1�40 CD <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ <br /> N <br /> TYPE OF PERMIT(S): cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION m <br /> STRUCTURE/ADDITION USE: 'IV <br /> r� ✓ 1 7 <br /> (Home/Cabin; Commercial Business; Bedroom; eck; etc.) rn <br /> BUILDING CONTRACTOR: <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'h X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3, <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> M N O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF �/�p <br /> Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 1 <br /> 0 <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. <br /> Dj <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. 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN m ° <br /> NEEDED. C a <br /> v <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o ^ y <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. 1 <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, 10 <br /> iCL <br /> 3 � p <br /> 6. '� m LM "c ' 3 <br /> 2 " <br /> 7. ? ' ` rn <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ( [3 c c <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of cl: c <br /> all information contained in this application(including any accompanying schedule)and I further declare that Irecognize m m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- S ' l7 <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 3 E <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> CD <br /> w : <br /> SIGN HERE <br /> (signature of owner or building contr tor) (date) <br /> ZONING ADMINISTRATOR <br /> to w w fn fn w <br /> N P P <br /> 01 P fT N N <br /> fT U1 O (ll O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0000000 o o o <br />