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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 71 0_� Z <br /> APPLICATION FOR LAND USE PERMITS 3 � <br /> � <br /> y O <br /> N <br /> C <br /> OWNER TELEPHONE o <br /> HOME ADDRESS 6,,j 3 5 5 ,,v ff0yo <br /> �/1l / r <br /> EMERGENCY/FIRE NUMBER ROAD NAME�U5, j/ J GK �QD4� a o <br /> t <br /> 7-f-)( -#01T 3;0/ 03 M,; I► l <br /> LEGAL DESCRIPTION see tax receipt) c,-' 3L') 5 5 ✓ cn <br /> \ <br /> DWELLING/BUILDING 1:1GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY I c 0 <br /> TYPE OF PERMIT(S): Cr <br /> FILLING/GRADING ❑ CA NG UNIT ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabir#Commercial Business; Bedroom; Deck;etc.) rn <br /> m <br /> BUILDING CONTRACTOR: 5f <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> M <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 0 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE Im fD <br /> NORTH(N). y 3 <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. P <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 cKZ <br /> MUST BE SIGNED AND DATED BY THE OWNER. c 1 <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN cr <br /> NEEDED. 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c �- <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 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 r� <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> zv0r- oLCD CL rn <br /> ov <br /> 6 COD <br /> 'M <br /> COD <br /> 7. .0 i N �'< ' .'D <br /> =U): m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of a o 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 C <br /> sue a permit. 1 further accept all liability which may be a result County of Burnett relying on this information I amm <br /> providing in this application. I agree to permit county officials char th administering county ordinances or other <br /> authorized person to have access to the above described pre es at any a able time for the purpose of inspection. T <br /> CD <br /> SIGN HERE <br /> J l� .n <br /> 61 <br /> gnature of o ne r building co (date) <br /> ZONING ADMINISTRATOR fn <br /> N N N0 T <br /> u, �+ P o n�0 v, 0 0 <br /> TOWN IP PERMITS MAY BE REQUIRED o o 0 0 0 0 <br /> 0000000 <br />