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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator z <br /> APPLICATION FOR LAND USE PERMITS 3, ° <br /> N <br /> OWNER����© , TELEPHONE�;7/4--& <br /> O <br /> HOME ADDRESS �0��/�fi/ lf/�D �/J .) !'/ O <br /> 47 <br /> EMERGENCY/FIRE NUMBER ROAD NAM <br /> LEGAL DESCRIPTION(see tax receipt)��Q 9 �j�(� �/ r / C Q <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ o <br /> TYPE OF PERMIT(S): fn <br /> c <br /> FILLING/GRADING ❑ CAMPING UNIT IL`pp��l SUBDIVISION ❑ a: � ^- <br /> N <br /> STRUCTURE/ADDITION USE: <br /> �J� (H me/Cabin, Co mercial Busines B Broom; Deck; etc.) rn <br /> BUILDING CONTRACTOR(>y/lYxwt <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR N <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n 3 <br /> O <br /> y <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) 0 <br /> n CL <br /> m /� <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. o z <br /> 2 THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C � <br /> NORTHz <br /> ( ) !�- <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. o <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 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. -2 <br /> o w <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a o <br /> NEEDED. <br /> 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z <br /> CONDITIONS OF PERMIT. P n�11 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT HCl W <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 <br /> SETBACK AREA. <br /> 5. <br /> 6. <br /> J �� <br /> C:r��`VVV�� � O : ID C Vl y > > <br /> 7. V z : MW � 1 <br /> IZI <br /> =rn : m <br /> I declare that this application (including any accompanyi edule�J�j been examine a and to the best of my t7 Cr <br /> knowledge and belief it is true,correct and complete. 1 <br /> lac ledge thM4 a� re�ss Bible for g tletail and accuracy of m' '. c <br /> all information contained in this application(including any acc ►►ii�i Ing scheNLl I fu r' eclare that I recognize ' m m ; m <br /> that this information 1 am providing will be relied upon by the CCFtlil�ttett Wisconsin ' ( Cermining whether to !s- <br /> o <br /> s- p <br /> sue a permit. I further accept all liability which may be a result of the ty(p tt re in 'on this information la m <br /> providing in this application. I agree to permit county officials char � {�g county ordinances or other <br /> authorized person t have access tot above described premises at any reas able time for the purp se of inspection. <br /> m : <br /> m : <br /> ME <br /> SIGN HERE (d' <br /> (signature of owner or building contractor) (date) <br /> ZONING ADMINISTRATORyl <br /> to cn(n f»fn in <br /> N NInNNcn <br /> fr1 (r 0 VI fT PO 0 O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />