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(5�" <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administratoro 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> o <br /> N <br /> CD <br /> OWNER �t TELEPHONEII 3p�lJ ^p J) <br /> CD <br /> HOME ADDRESS ed � <br /> _ <br /> r � <br /> EMERGENCY/FIRE NUMBER ROAD NAME ,Qa (a <br /> f <br /> LEGAL DESCRIPTION(see tax receipt) NW CD <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTUXL-J ADDITION ❑ PRIVY L-1 � 0 <br /> TYPE OF PERMIT(S): �j—[�'- � <br /> FILLING/GRADING ❑ CAMPING UNIT UBDIVISION <br /> N <br /> STRUCTURE/ADDITION USE: 1 <br /> (Home/Cabin; Commercial Business; Bedroom; D ck; etc.) C <br /> BUILDING CONTRACTOR: " \ <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3. <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O CD <br /> T <br /> ?1 6 Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> NORTH(N). 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. ° <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 <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. F 1 <br /> 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. o <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. vl/ <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 /> 5. -001— Dvaov <br /> CD <br /> �< m = 0 M a w Mo <br /> 6. m - 3 <br /> "� (D C fn O = <br /> Z : N m O <br /> O T : XI <br /> 7. <br /> = cn : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my w C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of fa <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m CD 0 <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- O <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. I agree to permit count officials charged with administering county ordinances or other <br /> P 9 Pp 9 Y 9 9 tY m . <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. T <br /> CD <br /> CD : <br /> en <br /> SIGN HERE <br /> re f p/wne�r or building n ctor) (date) <br /> ZONING ADMINISTRATOR /yL . ' <br /> 9WNSHIP PERMITS MAY BE REQUIRED <br />