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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o° o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> rt r- <br /> y o <br /> �n c <br /> OWNER QIA4 <br /> TELEPHONE <br /> (/� TELEPHONE o <br /> m <br /> O <br /> HOME ADDRES <br /> 0 <br /> 0 <br /> EMERGENCY/FIRE NUMBER 1 / ROAD NAME ) <br /> LEGAL DESCRIPTION (see tax receipt) L � V '� �a[�I / , / �/3��� o <br /> YY rn <br /> n <br /> e <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION PRIVY El rn o <br /> TYPE OF PERMIT(S): ii <br /> FILLING/GRADING CAMPING UNIT ❑ SUBDIVISION 3 n <br /> N' <br /> m � � <br /> STRUCTURE/ADDITION USE: I/ is10 � <br /> (Home/ abin; Commercial Business; Bedroom; Deck;etc.) rn <br /> BUILDING CONTRACTOR: ` fii Cn` <br /> v <br /> M <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o �\ <br /> o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). y 3 <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. v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN a ° <br /> NEEDED. 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. P <br /> CONDITIONS OF PERMIT: �Q ' <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 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> � M. WLim <br /> 6. �� v ain inr= 3 <br /> � m C m o � <br /> COD <br /> 7. o N < <br /> = cn : 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 n <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 1 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 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. -n <br /> CD : <br /> CD : <br /> SIGN HERE <br /> (signatur of ow r or building contractor (date) <br /> 1 r <br /> ZONING ADMINISTRATOR <br /> wwfntntnEn� <br /> N NN N N (A <br /> to UtON [TOP <br /> C) 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 <br /> 000000 <br />