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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -o ci Z <br /> APPLICATION FOR LAND USE PERMITS 3 ° <br /> N � <br /> N <br /> C <br /> OWNER a <br /> TELEPHONE <br /> o <br /> HOMEADDRESS ® yyL/ � � 11k 0 <br /> EMERGENCY/FIRE NUMBER3/ m <br /> �� ROAD NAME ILIe/�sU� <br /> I <br /> LEGAL DESCRIPTION(see tax receipt) 5,E/ /UY j/ <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION PRIVY ❑ o' <br /> TYPE OF PERMIT(S): co <br /> FILLING/GRADING GING UNIT ❑ SUBDIVISION ❑ a <br /> c)tif� J <br /> STRUCTURE/ADDITION USE: v/� o A o <br /> (Home/Cabin; Commer al Business; edroom; D ;etc.) <br /> BUILDING CONTRACTOR: <br /> PF <br /> m <br /> T <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/z X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n 3 <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) H <br /> O m <br /> -n n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T ? <br /> v <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <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. Z <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO O <br /> BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> IN <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. 0 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN O Q� <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: o Q <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 G <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 6. m- V 0g 0Da �v <br /> fm <br /> "O m C y N O �' 3 <br /> 7. N O O t -I <br /> o : �1 <br /> T' <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my A <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m <br /> all information contained in this application(including any ac-c.1 anying schedule)and I further declare that I recognize m <br /> that this information I am providing will be relied upon by the: urltr� rnett Wisconsin in determining whether to is- l7 <br /> sue a permit. I further accept all liability which may be a re i c/f1 0Ayrnett relying on this information I am m <br /> providing in this application I agree to permit c my offli s c� tl '� i county ordi nces or other <br /> authorized person to have cess to the ve cribed ises at any b fQt p o e of inspection. m <br /> -n <br /> SIGN HERE , v� <br /> ign ur er or building co ! (date) <br /> ZONING ADMINISTRATOR <br /> WNSHIP PERMITS MAY BE REQUIRED <br />