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0-n-C-Af)� <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 L7 Z <br /> APPLICATION FOR LAND USE PERMITS 3° <br /> r (� <br /> N ON y`) <br /> N <br /> OWNER bL TELEPHONE �'6to <br /> m <br /> HOME ADDRESSO <br /> mow— F <br /> CD <br /> r m <br /> EMERGENCY/FIRE NUMBER St� ROAD NAME 1 0 <br /> CJ 1 <br /> LEGAL DESCRIPTION (see tax receipt) N <br /> DWELLING/BUILDING ❑ GARAGE/ACCESS YSTRUCTUREg ADDITION ❑ PRIVY ❑ 0 <br /> N <br /> TYPE OF PERMIT(S): � <br /> FILLING/GRADING CAMPING UNIT ❑ SUBDIVISION ❑ �°: <br /> STRUCTURE/ADDITION USE: <br /> (tow, a n; C rcial Business; Bedroom; eck; etc.) }� <br /> m <br /> BUILDING CONTRACTOR: <br /> CD <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n 3.— <br /> O — <br /> N p <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p � <br /> n a <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. TI � <br /> (� m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m ;0 <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 El <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OH <br /> WM)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 OCA <br /> BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS C <br /> MUST BE SIGNED AND DATED BY THE OWNER. 0 <br /> f <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN �' o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: 1 <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. <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 t <br /> S TBAC(LAREA. <br /> 5 This structure to be used as private residential <br /> garage/storage only. Not to be used for humanCD d d > 0 a� m <br /> 6. habitation. <br /> CDD7. C N N p Ei3 <br /> P T Q : A <br /> — Cn <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best oA <br /> f my ID <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m 0 m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize <br /> that this information I 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. 1 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. `D <br /> m <br /> CD <br /> SIGN HERE <br /> 7t ow er or building cINC <br /> ontrac r) ( e) <br /> ZONING ADMINISTRATOR <br /> i <br /> �-yip- i�36i � <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />