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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v O Z <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> - r <br /> y O <br /> C <br /> CD <br /> OWNER 1/lNl/ TELEPHONE rf� _ / o l� <br /> HOME ADDRESS (o O <br /> r m <br /> EMERGENCY/FIRE NUMBER �l ROAD NAME 41) <br /> LEGAL DESCRIPTION(see tax receipt) L, y le/.A661 TCS <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE�I ADDITION PRIVY ❑ \•' y <br /> TYPE OF PERMIT(S): �/� <br /> FILLING/GRADING ❑ CCA'►MPINGUNIT ❑ SUBDIVISION ❑ ����'r 5 <br /> STRUCTURE/ADDITION USE: 15i�L o-jo 3 o� Ya 4 X I VT. <br /> (Home/Cabin ommerciai Business; Bedroom; Deck;etc.) y <br /> BUILDING CONTRACTOR: I�/ <br /> v <br /> A PLOT PLAN MUCD <br /> ST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR fb <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> O <br /> ;a c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p <br /> n CL <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m 9 <br /> NORTH(N). a 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 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 ) <br /> BUILDINGS,ROADS,LAKE,LOT LINES. i Cs <br /> S. 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 ( 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN0 <br /> NEEDED. `t <br /> '�n� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c "(I <br /> CONDITIONS OF PERMIT: <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. N <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WIT '�/, 7; WATER <br /> SETBACK AREA. <br /> 5. <br /> M 'V n O O <br /> 6. A10 1 2 3 <br /> 7. e�ANF l���d D : <br /> o � <br /> _ Cr : m <br /> I declare that this application (including any accompanying schedule) has been a and t best of my c p <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am respo d accuracy of m c <br /> all information contained in this application(including any accompanying schedule)and 1 her dec are 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- 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 m' <br /> providing in this application. 1 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 /> m : <br /> SIGN HERE <br /> (s gna re Qf owner or uildin actor) (date) <br /> ZONING ADMINIST ATOR <br /> R cNii uNi o 0 <br /> TOWNSHIP PERMITS MAY BE REQUIREDo o 0 <br />