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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> a <br /> OWNER LL& irr TELEPHONE <br /> o <br /> HOME ADDRESS ��L( <br /> 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME w PL Q� <br /> Ls ?rr�r 1 �D -/� <br /> v� <br /> LEGAL DESCRIPTION (see tax receipt) ° <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION❑ PRIVY ❑ ° <br /> TYPE OF PERMIT(S): i , n <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ 33 X 6—� � QyF� <; <br /> T. <br /> STRUCTURE/ADDITION USE: "Om!! � <br /> (Home/Cabin; Commercial Business; Bedroo ; De k'etc.) w <br /> BUILDING CONTRACTOR: Vffo <br /> CDm <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/x X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n B <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O _. <br /> y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n n <br /> m <br /> T � Z <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 C n <br /> NORTH(N). Ch 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. I ° <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 PLANSQYj. <br /> MUST BE SIGNED AND DATED BY THE OWNER. ° <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT / <br /> ISSUANCE. V 11 (�' -� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> ` (,� <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 i uQ►t ln.�� <br /> 5 SETBACK ARyj . II�,,, � ke r��e� t o A/ <br /> 06. 4r 4 a ^ I � v am xn <br /> 7. C rrnn <br /> I de are that this application (includin an accom an in schedule has been examined b me and to the best of my A <br /> pp 9 Y P Y 9 ) Y G cc 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 <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- CD <br /> r G) <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. T <br /> CD <br /> m <br /> SIGN HERE <br /> (signature of owner or buildin o ctor � (date) <br /> ZONING ADMINISTRATOR 1 <br /> TOWNSHIP PERMI S MAY BE REQUIRED <br />