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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator r - O o <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> �J r <br /> U / m o <br /> c <br /> OWNER TELEPHONE +CLQ o O <br /> D ICD <br /> HOME ADDRESS <br /> CD <br /> EMERGENCY/FIRE NUMBER ROAD NAME �%J �� �J► /Y i o <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CD �, <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION 1:1 PRIVY El •�' cn 0 <br /> TYPE OF PERMIT(S): a <br /> or <br /> FILLING/GRADING ❑ CAMPING UNIT ❑,/ S IVISION a NZ <br /> � <br /> STR40UCTURE/ADDITION USE: Csm V /y �' 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) / <br /> O <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR D NZI3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> O <br /> Z1 y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n o z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m9 � 61 <br /> NORTH(N). Cn <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 <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. o1a <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO r�> <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 /> E <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. <br /> 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. ZO <br /> CONDITIONS OF PERMIT: o �j ep <br /> qj <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 rr <br /> PERMITTED. y <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER �\ <br /> SETBACK AREA. <br /> 5. <br /> �D r � OQO � <br /> d <br /> 6. CD 3amxaD .� <br /> o' : (D C: <br /> 7. � 'D o � � <br /> o m <br /> Cn A <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G) = c <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of ` m 0 m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize CD <br /> O <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 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. fD <br /> -n <br /> N <br /> D <br /> SIGN HERE <br /> (signature of ner or building contra r) (date) <br /> ZONING ADMINISTRATOR CZJ7/ �' <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />