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BurnettLounty 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administratoro 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> N <br /> U) <br /> 5 <br /> �J� / Q C L <br /> OWNER TELEPHONE <br /> � <br /> O <br /> HOME ADDRESS L �_ ,OO 0 <br /> — O <br /> r m <br /> 0 <br /> EMERGENCY/FIRE NUMBER S ROAD NAME <br /> / / <br /> LEGAL DESCRIPTION(see tax receipt) rT S�CTT 3 /!/ �yy/ co <br /> m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ o <br /> TYPE OF PERMIT(S): y <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: c <br /> 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) y <br /> BUILDING CONTRACTOR: Er <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR E <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> 3. W <br /> H <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p m <br /> T o' <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n <br /> m Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). C n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m ` 9 <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. ( c <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> o 9 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHENq 0 <br /> NEEDED. C <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z <br /> o <br /> CONDITIONS OF PERMIT: ) <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT QJ <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 /> pm 6. m m <br /> o M <br /> CO m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Zj c A <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m0ff <br /> : C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m ;U <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m ? p <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 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> fifi m : <br /> SIGN HERE � <br /> �I I — `s . <br /> (signatun of owner <br /> oorbuilding contractor) (date) <br /> Pon) � <br /> ZONING ADMINISTRATOR _ v►ro <br /> n) (� \ '• <br /> d �fh fH f»fn � <br /> N N (nNN Ut <br /> VI V7 05A Vt O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 6 <br />