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QhC e7- yzj,c7 <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> N 0 <br /> c <br /> OWNER TELEPHONE <br /> HOME ADDRESS ? O <br /> r � <br /> EMERGENCY/FIRE NUMBER ROAD NAME r' <br /> LEGAL DESCRIPTION(see tax receipt) _1 q SY d� �� in <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ 11`37 <) CO ° <br /> TYPE OF PERMIT(S): 10 v <br /> FILLING/GRADING ❑c CAMPING UNIT ❑ SUBDIVISIONS Y a <br /> ,O <br /> STRUCTURE/ADDITION USE: �✓rn 1-7 / 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; tc.) to <br /> BUILDING CONTRACTOR: <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 9 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> M <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n O <br /> -n z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE IF <br /> NORTH(N). y �o <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. 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. <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 � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q ° G <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z <br /> CONDITIONS OF PERMIT: o { <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. I 1 <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. ty© <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> z v n r O CCD 0 CL <br /> m <br /> 6. m cH o 3 <br /> R COD <br /> 7. 0 <br /> =o' m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 6 c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of �'� a <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize 0 '; : 'm : E <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 <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. -n <br /> m <br /> m : <br /> dr <br /> SIGN HERE <br /> (signature of ner or building con ctor) (date) <br /> ZONING ADMINISTRATOR <br /> fnv+ww+nw� <br /> f71 NOutNOO <br /> T NSHIP PERMITS MAY BE REQUIRED c o o b o 0 0 <br /> o000000 <br />