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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator ' v 0 Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> N <br /> UT 0 <br /> C <br /> OWNER" LL(�,TELEPHONE�o <br /> � J - c C <br /> HOME ADDRESS ma �� �� L� Q�i�' �n�� <br /> r <br /> 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME ' ~ <br /> LEGAL DESCRIPTION (see tax receipt) �� *SIC- CD <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ O N <br /> TYPE OF PERMIT(S): <br /> FILLING/G'Rff.ING ❑ CAMPING UNIT ❑ SUBDIVISION <br /> a <br /> N <br /> STRUCTURE/ADDITION USE: <br /> Ho !Cabin; Commercial Business; Bedroom; Deck; etc. rn <br /> y, d <br /> BUILDING CONTRACTOR: <br /> V <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n W <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n A ` <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m c}�P <br /> NORTH(N). <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 o <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 <br /> BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N 1 <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 /> 0 <br /> CONDITIONS OF PERMIT: <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. 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 <br /> SETBACK AREA. <br /> MM. W W D O D * m <br /> 6. B CO 0 0 CD ;U <br /> (D C 0 m 4 <br /> 7 A N O 7a <br /> O -n m <br /> —�' AI declare that this application (including any accompanying schedule) has been examined by me and to the best of my L) 2 c <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of d 0 <br /> c <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- <br /> 0 : <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. m <br /> m : <br /> CD <br /> m : <br /> ,69 : <br /> SIGN HERE <br /> (signature owne or building contract (date) <br /> ZONING ADMINISTRATOR <br /> TOW HIP PERMITS MAY BE REQUIRED <br />