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0 ? ut <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator {'� � 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> •* r <br /> N 0 � \ <br /> OWNER f`Rt� • �C�/ TELEPHONE �S( 11��SQ �✓ <br /> 0�1 <br /> HOME ADDRESS y 1 �' '�( \ II`.,�.1.,, m� .0 <br /> vk <br /> EMERGENCY/FIRE NUMBER ROAD NAME /K^) o <br /> LEGAL DESCRIPTION (see tax receipt) 1 0 m <br /> m <br /> 0 <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY Cn <br /> TYPE OF PERMIT(S): v <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ 5 <br /> m <br /> STRUCTURE/ADDITION USE: <br /> C (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) <br /> r <br /> BUILDING CONTRACTOR: <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR TO '3 L <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEVO 0 o _ <br /> ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m e <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). CO) o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO n1 <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. P <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. <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. ro' o <br /> o � W <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN q <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <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. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER (>j <br /> SETBACK AREA. <br /> 5. <br /> X 'oOn2e �U- ;M0 <br /> m �• 3m 6. �' Cti <br /> 7. c m �'< <br /> _or : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my {�? c p <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy ofCL <br /> 1 <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to is- <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 m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> CPCD : <br /> .+ w <br /> v SIGN HERE <br /> /\ (signature owrier or building contra r) (date) <br /> ZONING ADMINISTRATORw <br /> � w v+w fn <br /> N N N N N <br /> NON V1 O <br /> WNSHIP PERMITS MAY BE REQUIRED <br /> 00000 <br />