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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v c1 Z <br /> APPLICATION FOR LAND USE PERMITS 3 ° <br /> n r <br /> y O <br /> J,� N <br /> OWNER TELEPHONE lis- <br /> o0i <br /> HOME ADDRESS C� 7 '�fZ V/r, /� /► j / �' C��` ` , 1 �? <br /> J ( C O <br /> 5 <br /> EMERGENCY/FIRE NUMBER c23937 — <br /> ROAD NAME <br /> /I <br /> LEGAL DESCRIPTION(see tax receipt� '� r J"-`L/ / �� n 5 ,/ n� L_� rvI <br /> (( 4 ` Upps� J Y , 0 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION 1^J PRIVY ❑ y c y <br /> TYPE OF PERMIT(S): � J <br /> c <br /> FILLING/GRADING 0 CAMPING UNIT ❑ SUBDIVISION ❑ Cr <br /> CL <br /> STRUCTURE/ADDITION USE: O/YI to, <br /> H. <br /> 0 <br /> _ 1 (Home/Cabin, Commercial Business; Bedroom; Deck;etc.) ' <br /> Cn <br /> BUILDING CONTRACTOR:_ rl <br /> -i <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 71 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T 3 c <br /> DIRECTIONS FOR PLOT PLAN DRAWING• (AERIAL OR TOP VIEW) 0 " <br /> c <br /> -n o. <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T v Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m `? n�,' <br /> NORTH(N). C <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDINGS)TO ALL LOT LINES,(B)BUILDING(S)TO m v r 1 <br /> CENTERLINE OF ROAD,(C)BUILDINGS)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 <br /> BUILDINGS,ROADS,LAKE,LOT LINES. <br /> 6. 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 ( 0 ) <br /> MUST BE SIGNED AND DATED BY THE OWNER. vo <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a 0 <br /> NEEDED. 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITION OF PERMIT: 0 6 I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. <br /> 2. REMOVAL 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. ( W 0 k 0 � <br /> � �. � � C m <br /> am <br /> 7, <br /> Z 401! G N > <br /> 0 : <br /> �� •� <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Cr Cr : m <br /> i <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m I, c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m M <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m <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 <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 /> ; /m : <br /> SIGN HERE <br /> (signature of owner or building contractor) ! (date) <br /> ZONING ADMINISTRATOR <br /> N N01NNCn(,n <br /> Of Ut 011l N OO <br /> TOWNSHIP PERMITS MAY BE REQUIREDO G o 0 <br /> 0000000 <br />