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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -U o° o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> N 0 <br /> C <br /> OWNER � w!/ Y F �[�2�����iCITONE <br /> /�T E <br /> HOME ADDRESS 904/ CJ7-1 o (`lt <br /> r C- <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) 9 L7 A 6 6 /VF�(,J <br /> lt� N <br /> y <br /> DWELLING/BUILDING ElGARAGE/ACCESSORY STRUCTURE 1:1 ADDITION ElPRIW ❑ O� <br /> TYPE OF PERMIT(S): C <br /> FILLING/GRADING 11CAMPING(1NIT ❑ SUBDIVIS5NX� CL` <br /> N <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Cdm'ercia^I Business; Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: <br /> M <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8Ya X 11 SHEET OF PAPER. ANY INCOMPLETE OR In <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> N <br /> C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 <br /> n c <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m �A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C :° n <br /> NORTH(N). y ° <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDINGS)TO m a <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF \� <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. V ° <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. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS N <br /> MUST BE SIGNED AND DATED BY THE OWNER. Q <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN Cr B <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o 41' <br /> CONDITIONS OF PERMIT: k�{ w <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT W <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 a p) <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. � r0 v <br /> 6. C N O 7 <br /> N 'C'D <br /> O O <br /> �K <br /> 7. O — <br /> o' i [ m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my i3 2 i IS <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of o E S <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize 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- y <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 d <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. T <br /> m : <br /> CD : <br /> � S <br /> SIGN HERE <br /> (sign ure of owner or building co ctor) (date) <br /> ZONING ADMINISTRATOR <br /> N U O N N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />