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o)� <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 'U G) Z <br /> APPLICATION FOR LAND USE PERMITS 3. ° <br /> m �f,\ <br /> 4 W <br /> OWNER r G V r TELEPHONE 7jS-y 3 -'._S- j W <br /> o <br /> HOME ADDRESS ,,,?� 9�T eo �/ CD <br /> CD <br /> EMERGENCY/FIRE NUMBER ROAD NAME A <br /> P <br /> LEGAL DESCRIPTION (see tax receipt) D 3 1 rn <br /> m <br /> DWELLING/BUILDING ARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ y o' <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> STRUCTURE/ADDITION USE: h o n e o l" <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) � <br /> BUILDING CONTRACTOR: 0 U Yl Q a h Q LL S e --T\ lay) d <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. T - <br /> O <br /> A N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> n a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m a <br /> NORTH(N). c n <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)OFZ <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. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 0 I <br /> MUST BE SIGNED AND DATED BY THE OWNER. o w <br /> F <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN g <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: ° <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. lu <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 n r D O D v <br /> (D WW 0 (D o f m <br /> 6. 0a m Co `^ o 5 3 <br /> 7. Z : rn m o <br /> T <br /> _cn A <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my I72: c <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of n 0 <br /> all information contained in this application(including any accompanying schedule)and I further declare that Irecognize m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whethm <br /> er : v <br /> to is- �j <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 h e access to the above described premises at any reasonable time for the purpose of inspection. fD <br /> n ID <br /> m <br /> SIGN HERE <br /> K� <br /> 7^d - a00( <br /> (signature of owner <br /> -or,building contractor) (date) <br /> ZONING ADMINISTRATOR JTY) f Id1 11({ <br /> I � <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />