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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 /> M O <br /> C <br /> N <br /> TELEPHONE <br /> OWNE�- TELS ` = p <br /> m <br /> 0 HOME ADDRESS o°l <br /> m <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> / , `/ !� 3s—U <br /> LEGAL DESCRIPTION(see tax receipt) PC I+ � t' wT OSI <br /> Q <br /> DWELLING/BUILDINGGARAGE/ACCESSORY STRUCTURE ElADDITION ❑ PRIVY ❑ a <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING CAMPING UNIT ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITION USE:� I/t/I140 <br /> (Home/Cabin; Commercial Business, Bedroom;Deck;etc.) m <br /> BUILDING CONTRACTOR: �WA <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'h X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 y <br /> c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n o. <br /> ?r O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m X <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C c <br /> NORTH(N). Cn <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m a C <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF o <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. I N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS 0, <br /> MUST BE SIGNED AND DATED BY THE OWNER. ° _C <br /> v „1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN a <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: (j — <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT X(tJ <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. }U.1 <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. m � Lm <br /> COD ' <br /> 0. 0 '^o j 3 <br /> 6. N N O : 7O <br /> o ' � <br /> 7. _o) : <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my t7 c <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of f o B <br /> all information contained in this application(including any accompanying schedule)and I further declare that Irecognize 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- o0i l7 <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 /> SIGN HERE <br /> (signature of owner or btu.lldf ing contractor) ( ate) <br /> ZONING ADMINISTRATOR \ / I / / � `� <br /> to N to to cn <br /> N (N7i0 (NIiCA O <br /> O O O O O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 0 0 o O <br />