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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> u, o <br /> )019401,? • / <br /> OWNERTELEPHONE o. <br /> m <br /> / �� fp Q <br /> HOME ADDRESS _ N 0 <br /> r m <br /> 0 <br /> EMERGENCY/FIRE NUMBERROAD NAME T <br /> 30j <br /> LEGAL DESCRIPTION (see tax receipt) L� U`I/ <br /> ���^ F CT-&/ p�g— C <br /> DWELLING/BUILDING 1:1GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ 1 j <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING E] CAWOG UNIT ElS BDIVISION _ L' <br /> <_ <br /> N <br /> STRUCTURE/ADDITION USE: / <br /> (Home/Cabin; Co ercial Business; Bedroom; Deck; etc.) m <br /> BUILDING CONTRACTOR: lir <br /> K <br /> C <br /> W <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n IT ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) -n-n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> NORTH(N). fn ` o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDINGS)TO m 3 <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. <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. so c r <br /> o � � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN q ° <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: �C. <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. q, <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. <br /> t7 r O m O 0 <br /> 6. $ �`2 .°3nmxe1. 3_ <br /> 'o : mCmfeo � <br /> 0 <br /> 7. O y �� <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of o L <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- E D <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 m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> m <br /> M : <br /> SIGN HERE <br /> (signature of owner or building r tor) (date) <br /> , <br /> ZONING ADMINISTRATOR <br /> w En En Fn to to� <br /> N Nf11 NN (nN <br /> N V1 O Vt fll O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br /> 0000000 <br />