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Qy" �— <br /> Burnett County 74190 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator o <br /> APPLICATION FOR LAND USE PERMITS N <br /> CL <br /> OWNER ��� _ TELEPHONE <br /> HOME ADDRESS 1U l, Y 77 r <br /> EMERGENCY/FIRE NUMBER <br /> RAAD NAME <br /> AAD <br /> t <br /> g - �I�-l� Sy <br /> LEGAL DESCRIPTION (see tax receipt) IV a1sft m <br /> 1a! 7 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION LlPRIVY ❑ Cr <br /> a <br /> TYPE OF PERMIT(S): v S.L <br /> FILLING/GRADING ❑„CAMPING UNIT SUBDIVISION �— ` y <br /> STRUCTURE/ADDITION USE: a) <br /> (Home/Cabin; Commercial Business; Bedroo ,Deck;etc.) <br /> i3 <br /> BUILDING CONTRACTOR: <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR O 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. M <br /> CD <br /> In CL <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) <br /> A <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. INGS(NB)AND INDICATE m C <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDrn 3 <br /> NORTH(N). m <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF oZ <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. sl <br /> ED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANN <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS S o <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. (`�K( <br /> Z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. P <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 1 <br /> ISSUANCE. <br /> CUTTING2. REMOVAL OR VEGETATION IS RESTRICTED ALONG SHO <br /> 3. NO GRADING OR SHO ELAND ALTERATIONS AREALOWED UNLESS SPEC F CALLY LINE. <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> p 0 r- <br /> a) H <br /> 5. m = m0) a <br /> . � R- <br /> � ,� 3 nm i'cQ _ <br /> 6. <br /> O : N Q <br /> � rn <br /> 7. m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ? C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> CL <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize OfiQ <br /> i i m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m t7 <br /> sue t permit. 1 tion I accept all liability which may be a result of the County of Burnett relying on this information I am ro <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 /> SIGN HERE (date) <br /> (signature of owner orb ilding contractor) <br /> . to <br /> ZONING ADMINISTRATOR <br /> N N (n NN (T UI <br /> U1 NONp100 <br /> O 0 0 0 0 0 0 <br /> TOWNSHI PERMITS MAY BE REQUIRED <br />