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Z <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator - o o <br /> APPLICATION FOR LAND USE PERMITS <br /> r <br /> o <br /> N <br /> l <br /> �] C <br /> OWNER / / TELEPHONE Y6 6 — /77 Z n <br /> O <br /> aHOME ADDRESS � � 412 <br /> r m <br /> O <br /> EMERGENCY/FIRE NUMBER ROAD NAME I <br /> LEGAL DESCRIPTION(see tax receipt) W -)7— �lpCn <br /> O <br /> M <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ElADDITION 1:1PRIVY ❑ V) ° <br /> TYPE OF PERMIT(S): Q ' <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ S BDIVISION S. r <br /> sr� �' i� -/J -7 y <br /> STRUCTURE/ADDITION USE: � <br /> (Hoom�e/Caabin; Commercialm <br /> JBusiness; Bedroom; eck;etc.) <br /> BUILDING CONTRACTOR: �1/Gri/ �( /I <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. <br /> :0 N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m M <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). N o <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(OH <br /> WM)OF <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. I <br /> 6. 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. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q ° <br /> NEEDED. <br /> D <br /> Pj <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <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. I <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY n 1, <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER 1 <br /> SETBACK AREA. <br /> 5. <br /> ;av0r,- 0 0 <br /> 6. (D x a <br /> N C y y O j <br /> Z : R (D =f0 <br /> 7. ° : <br /> U) : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my tj c C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of E <br /> all information contained in this application(including any accompanying schedule)and I 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- 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 county officials charged with administering county ordinances or other CO <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> m : <br /> M : <br /> SIGN HERE <br /> (signature owner or building con ct �) (date) <br /> ZONING ADMINISTRATOR ` v�v, . . . Fn <br /> 4a4040404040— <br /> N N O1 N N Ot 01 <br /> N OiON0�00 <br /> WNSHIP PERMITS MAY BE EQUIRED 0 0 0 0 0 0 0 <br />