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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 . Z <br /> N � 1 <br /> n. <br /> OWNER \Q �\(�� TELEPHONE<1S 03�— /-�7j o00 <br /> m <br /> CD O <br /> 5 <br /> HOME ADDRESS \� 1� L2 <br /> EMERGENCY/FIRE NUMBER <br /> 11 o/ ROAD NAME \`C\ v`�� ° <br /> �a-A3 1, o a. %(3(-) ][, 4� � <br /> LEGAL DESCRIPTION(see tax receipt) N1n$ iA � L.\ � �N rtV� T� \� m pq <br /> (Q <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY o <br /> TYPE OF PERMIT(S): I <br /> FILLING/GRADING ❑ MMPING UNIT <br /> ❑�ySUBDIVISION ❑ <br /> STRUCTURE/ADDITION USEDI `vim <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) C <br /> BUILDING CONTRACTOR: <br /> v <br /> m <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. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 o <br /> ?+ o z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C <br /> CD <br /> NORTH(N). 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO M 'R <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF \ L z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. Q� ° <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF), N + NCES TO (N <br /> BUILDINGS,ROADS,LAKE,LOT LINES. �% 1 <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GR EC / N gJ <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER, NTRACTOR, C5 T PP C <br /> 02 <br /> MUST BE SIGNED AND DATED BY THE OWNER. NO ° <br /> QQ , r o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFISAT,ION MAY BE�DIHEN ° <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z0IOJIN QUNTy o <br /> CONDITIONS OF PERMIT: q <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. <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 Ull <br /> SETBACK AREA. <br /> 5. m 0CD:Em <br /> OLD. <br /> < D <br /> m a <br /> 6. N �c <br /> '° : N C <br /> 7. o C m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of myG) <br /> 2i ic <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize \: CD M. <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- i �j <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 CD <br /> o <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. n <br /> CD : <br /> m <br /> SIGN HERE <br /> �I-1`I f�j— C)l En : <br /> (si ure of owner or b Id n on rector) (date) Q' <br /> ZONING ADMINISTRATOR \ <br /> C <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />