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Burnett County 7410 Co. Rd. K, No. 102, Siren,W154872 Office of Zoning Administrator v 0 Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r (� <br /> m 0 <br /> N <br /> (\� <br /> V <br /> OWNER AY�f,/'` G,� i Q, TELEPHONE 7<�J O I h <br /> it <br /> HOME ADDRESS <br /> r � <br /> EMERGENCY/FIRE NUMBER <br /> U 7 J ROAD NAME WOO <br /> 1 <br /> LEGAL DESCRIPTION(see tax receipt) L f � � �- --� Vo --� <br /> it <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ ( m ° <br /> TYPE OF PERMIT(S): c 3n <br /> FILLING/GRADING/❑ CAMPING UNIT El SUBDIVISION E] Q: <br /> STRUCTURE/ADDITION USE: C•-QN �I 2 . 0 <br /> (Home bin; Commercial Business; Bedroom; Deck;etc.) m <br /> m <br /> BUILDING CONTRACTOR: E <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR ,n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> x H <br /> In <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) a <br /> � o Z <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 O <br /> NORTH(N). CO) 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m ° <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. o <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. �� o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN q ? l <br /> NEEDED. 0 �J <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <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. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. ` ( !/� e-d <br /> 6. C ,y/� {� ( / CID� M. nr OCOm <br /> m -• <br /> a Cy 0 � 3 <br /> 1 @ N O O f0 <br /> 7. /1� 11/1 .� D `G M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ! 3, C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of mE <br /> all information contained in this application(including any accompanyiIngsc&edule)and I further declare that I recognize CIDm <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> sue a permit. I furper accept all liability which may be a result of thR County of Burnett relying on this information I am m E <br /> providing in this pp catio I a e permit county officials ch with administering county ordinances or other m <br /> authorized person o ave c es t the bove described premises at ar5y r�aso a time for the purpose of inspection. -n <br /> Thl� m <br /> SIGN HERE �'" �u . <br /> (sat�jo ner or building contractor) " (date) <br /> ZONING ADMINISTRATOR C42w <br /> vi w w cn F»v+ <br /> N N VINN (rfT <br /> ' V7 [n O V•Vt O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />