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Burnette dunty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 G)G) Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> 9r <br /> / vC o <br /> N <br /> C <br /> N <br /> OWNER TELEPHONECD <br /> o <br /> HOME ADDRESS f <br /> .Or. N <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> ( p> as- -/� �`�� r1 <br /> LEGAL DESCRIPTION see tax receipt) W <br /> CD <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCT RE ❑ ADDITION 1:1 PRIVY Elo' <br /> TYPE OF PERMIT(S): ' -- <br /> c <br /> o' <br /> FILLING/GRADING ❑ CAMPING UNIT 1:1SUBDIVI ON /// <br /> N <br /> STRUCTURE/ADDITION USE: 5 � 1\ <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;et . <br /> m <br /> BUILDING CONTRACTOR: iu <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 _- <br /> �l N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. i7 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <br /> n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <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. 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. `e <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN T S <br /> NEEDED. T <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z ' 1 <br /> CONDITIONS OF PERMIT: o W` <br /> W <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. 1 1 I <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. Wv0Cafm� <br /> 6. COD <br /> "O : m C y y 0 3 <br /> 7. N N O ' <br /> O 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 \ 2 c <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m <br /> that this information 1 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 am <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> -n <br /> (D <br /> (D <br /> SIGN HERE <br /> (signature of o or building contractor (date) <br /> t <br /> ZONING ADMINISTRATOR 4 <br /> TOW HIP PERMITS MAY BE REQUIRED <br />