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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator ' o° <br /> APPLICATION FOR LAND USE PERMITS 3. < <br /> r <br /> N 0 <br /> N <br /> C <br /> OWN �7 /�! - at . � •�2 TELEPHONE a, <br /> HOME ADDRESS / G0(/A,71 <br /> EMERGENCY/FIRE NUMBER S1446 ROAD NAME <br /> � // I <br /> LEGAL DESCRIPTION (see tax receipt) 3 ���� �jCsh� VIIUU� P& <br /> ,/ o <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITIONA PRIVY ❑ o0� y� <br /> TYPE OF PERMIT(S): C cr \ \J <br /> FILLING/GRADING ElCAMPING UNIT ❑ SUBDIVISION ❑ CL <br /> STRUCTURE/ADDITION USE: 'y t�pgQ�pn� //./O UL/ 0 <br /> (Home/Cabin; CommArcial Business; Bedroom; Deck;etc.) y <br /> BUILDING CONTRACTOR: <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/s X 11 SHEET OF PAPER. ANY INCOMPLETE ORn 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. In �f . <br /> ;a N W <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) Oo <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). N o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO rn G <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 1 <br /> BUILDINGS,ROADS, LAKE, LOT LINES. O <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 /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: 0 „ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT W <br /> ISSUANCE. 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <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. ,t�J� A v c) d �i <br /> 6. �(� � ( m3mmCD R-n=_ � <br /> J <br /> •w m cow y 0J 0 <br /> ' <br /> 7. COD <br /> O <br /> —y: <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my tj c 10 <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m C <br /> all information contained in this application(including any accompain'"schedule)and I further declare that I recognize m E <br /> that this information 1 am providing will be relied upon by the Co Z)%tif Wisconsin in determining whether to is- ' ' C <br /> sue a permit. I further accept all liability which may be a res4lty Ee <br /> elying on this information I am m <br /> providing in this application. I agree to permit county offic' charge i untyordinances or othermauthorized person to have access to the above described pI es at any reaso e rpose of inspection. T <br /> a m <br /> SIGN HERE <br /> (sw#ruraf owger or building co N �! (date) <br /> ZONING ADMINISTRATOR fn <br /> N N� N N Vt O1 <br /> Vt OOfTN00 <br /> 0 0 0 0 0 0 0 <br /> T WNSHIP PERMITS MAY BE REQUIRED <br />