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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> y O <br /> N <br /> N <br /> OWNERhU <br /> TELEPHONE <br /> p <br /> HOME ADDRESS <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) _^ m <br /> v) e <br /> DWELLING/BUILDING 1:1GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ® PRIVY ❑ m "a <br /> TYPE OF PERMIT(S): a <br /> Cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITION USE:Ve t✓K I D / X <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR:— P <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 71 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. ^, v <br /> �I N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p 1 <br /> n a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m 9 <br /> NORTH(N). C 0 <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 Z <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 /> S. 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 U� <br /> MUST BE SIGNED AND DATED BY THE OWNER. c <br /> o ) <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHENa g <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z <br /> CONDITIONS OF PERMIT: P <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. I <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHO INE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFIC P ) <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN T Q CG <br /> ."t <br /> SETBACK AREA. r r'� <br /> 5. S r� <br /> l A � Qr' OO6. � <br /> 7. W cawo> > z <br /> z <br /> O M <br /> =-r m <br /> I declare that this application (including any accompanying schedule) has been examine e s of my p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for Qbtall cc acy of ' m ' C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize CL <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 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 <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 ab ve described premises at any reasonable time for the purpose of inspection. m <br /> � . <br /> CD <br /> SIGN HERE ge <br /> (signature of owner or building contractor) (d te) . <br /> ZONING ADMINISTRATOR �JIal Han/� <br /> ^ v+cnFnwviFn� <br /> N N(11 NN N(T <br /> O� utONNOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 000000 <br />