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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Adminis rator - o 0 <br /> APPLICATION FOR LAND USE PERMITS . <br /> y O <br /> N <br /> c <br /> `�Q <br /> CD <br /> OWNER �� �f Q / }TELEPHONE '�Za c [Z 2 /7 2GA- <br /> n <br /> o <br /> d <br /> HOME ADDRESS d ors s <br /> r � <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> `LEGAL DESCRIPTION(see tax receipt) y <br /> M <br /> 2 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE{ ADDITION ❑ PRIVY ❑ ° <br /> c 0 <br /> T RMIT(S): �-a <br /> LING/GRADING ❑ CT. <br /> AMPING UNIT 1❑ SUBDIVISION ❑ p ' 1 U/ <. <br /> STRUCTURE/ADDITION USE: LQ �M Va 0 D0 �� Nu�S -lam I�— ' <br /> (Home/Cabin; Commerc al Business;Sel P Bedroom; D ck etc.) m <br /> I(o' � <br /> BUILDING CONTRACTOR: <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 VT <br /> A <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n n <br /> T ) Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m X <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). CA 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO rn a <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. 0 <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 ?, <br /> MUST BE SIGNED AND DATED BY THE OWNER. ° ° <br /> ° I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN <br /> N+ ° <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z LL <br /> CONDITIONS OF PERMIT: ° O <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ) <br /> ISSUANCE. Q <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. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. lq _ D=. W 0VDov <br /> ( <br /> . 0 >0> f m <br /> OLD. B O. 9 O r T ."0 <br /> D 3 <br /> 6. ^ 0 N y <br /> Z ° . <br /> 0 .0 <br /> 7. m <br /> _ -: : :AJO <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G) c <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofID m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize Q j <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- I" — : <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 /> G v <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or otherCD <br /> authorized person to hav access to the ab n e pr s any reasonable time for the purpose of inspection. <br /> CDm <br /> SIGN HERE <br /> (signature nor or building con ctor (date) <br /> ZONING ADMINISTRATOR C <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />