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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 ci <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> T r r <br /> y O Vl <br /> I N <br /> OWNER ,p9� f� / n <br /> TELEPHONE L Ui G7 -7l <br /> O <br /> HOME ADDRESS )T _ !" 0 <br /> Q ��� ` rr\U r �c�o <br /> EMERGENCY/FIRE NUMBER C1 ' / q ME 1 <br /> LEGAL DESCRIPTION(see tax receipt) y <br /> m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ y�\ o <br /> TYPE OF PERMIT(S): ) <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SU/BDIVISION q <br /> 5. <br /> STRUCTURE/ADDITION USE: C�_ � <br /> (Home/Cab`in; Commercial Business; Bedroom; Deck;etc.) y <br /> BUILDING CONTRACTOR: <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. 'n <br /> O <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) O <br /> CD <br /> -n a <br /> In 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. Z <br /> 0 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C 0 <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 <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. c <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. O <br /> S. 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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o G <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN W 0 <br /> o 0 <br /> NEEDED. cr <br /> 00 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. oZ <br /> CONDITIONS OF PERMIT: d <br /> 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT o <br /> ISSUANCE. 0 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. I 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 C 7I <br /> SETBACK AREA. <br /> 5. <br /> 6. m <�< 3�m m <br /> D a C 22 G T E <br /> 7. Z fn � !R � 1 <br /> O <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <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 accompanying schedule)and I further declare that I recognize C m ; m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- L7 p <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. <br /> io <br /> SIGN HERE d+ <br /> (signal a o�owner or building c t�raactor) (date) <br /> ZONING ADMINISTRATOR /Y �[2 <br /> N N (n N N(AM <br /> N UO (nU OO <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />