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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 1 - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> N 0 <br /> OWNER e� NCS p <br /> / m <br /> HOME ADDRESS 7 7 r' V —�a 4 <br /> ° <br /> EMERGENCY/FIRE NUMBER (;�^C'�((/GCl�IOAD LCEle� <br /> LEGAL DESCRIPTION(see tax receipt) y <br /> e <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE E] ADDITION 1:1PRIVY El0 c 0 <br /> TYPE OF PERMIT(S): r'Q� V� c <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION L6,. <br /> STRUCTURE/ADDITION USE: (f6&) 111 EI <br /> /P(::�?38�� <br /> � v <br /> r <br /> Home/Cabin; <br /> Commercial Bu 'ness;^Bedroom; Deck;etc.) C <br /> BUILDING CONTRACTOR: <br /> V <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) c O <br /> T �- <br /> T o Z <br /> 7. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C <br /> NORTH(N). to <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. ° <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. ° <br /> v � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN a ° <br /> NEEDED. n <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o .� <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. l <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. �C J <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. ;a - mivpR t�0t� o C <br /> 3 2, <br /> 6. m C m N O 9 <br /> y N 0 O 0 1` <br /> Z . <br /> 7. P : '1 <br /> = rnCt <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G\S i41s <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of ii B <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize ? m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m '• O <br /> sue a permit. 1 further accept all liability which may be a result of the County of Burnett relying on this information I am p <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other i e <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 HERE <br /> (signatu of owner or building co tractor) (date) <br /> ZONING ADMINISTRATOR /7q— w 49 <br /> • N NO� NNfn <br /> Ul NP N N 9 O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 O G C C <br /> 000000 <br />