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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872Office of ` ' <br /> Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS 3 4 C <br /> r A <br /> ��VtQ <br /> OWNER � TELEPHONE <br /> HOME ADDRESS a `� /� r �`, 7q lNX ., O <br /> r m <br /> EMERGENCY/FIRE NUMBER 5Z1 11 � ROAD NAME ru VV 4\ [� <br /> ,4 e l <br /> LEGAL DESCRIPTION(see tax receipt) S t, 1 3 � L Cn <br /> /V lz)l <br /> y <br /> DWELLING/BUILDIN GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ c c <br /> TYPE OF PERMIT(S): � <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ Cr <br /> a <br /> STRUCTURE/ADDITION USE: 19 7 f/{l�t) -7-721 <br /> (Home/Cabin, Commercial Business; Bedroom;Deck;etc.) a) �W <br /> BUILDING CONTRACTOR: <br /> 1 <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'%X 71 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. "n 3 <br /> DIRECTIONS FOR PLOT PLAN DRAWING• (AERIAL OR TOP VIEW) 0 " X <br /> T <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T o Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m 9 <br /> NORTH(N). C <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <br /> 0t, <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF a Z <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO o <br /> BUILDINGS, ROADS,LAKE, LOT LINES. <br /> 6. 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 0 C> <br /> MUST BE SIGNED AND DATED BY THE OWNER. 2. <br /> to <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a I` <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: o W <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT �I <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. <br /> a <br /> 7. <br /> v mCu'"i !' c� 3 <br /> P :: <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my v1 m <br /> c <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m m <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 a <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> m ' <br /> authorized person to ha cess to the above described premises at any reasonable time for the purpose of inspection. <br /> m <br /> ~ <br /> SIGN HEREow <br /> w <br /> (signature of owner o building contractor) (date) <br /> ZONING ADMINISTRATOR <br /> w cnwwavwCn <br /> Cn <br /> uppppppTOWNSHIP PERMITS MAYBE REQUIRED f-efyLASM 0000000 <br /> lk / 000000 <br />