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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> CD <br /> y, O <br /> N <br /> f � C <br /> OWNER TELEPHONE �js i Y C) / 0 1 <br /> o <br /> m <br /> HOME ADDRESS e � _� X 7`f " / v O <br /> r � <br /> EMERGENCY/FIRE NUMBER / eo ROAD NAME ( A o <br /> e "P <br /> LEGAL DESCRIPTION(see tax receipt) r� --3 /Or3��9 C <br /> DWELLING/BUILDING ElGARAGE/ACCESSORY STRUCTURE Is ADDITIONU PRIVY ❑ <br /> TYPE OF PERMIT(S): C ' <br /> Cr <br /> FILLING/GRADING EI CAMPING UNNIIT�❑ SUBDIVISION ❑ 7 - o; <br /> t � �G lel./ 1� N <br /> STRUCTURE/ADDITION USE: a�(,e 0 _ <br /> (Home/Cabin; Commercial Business edroom; Deck;-eM.) cn <br /> BUILDING CONTRACTOR: CD <br /> _ 6; <br /> C <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. T <br /> x N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T o <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). N o <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 <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. 01 :E 0 <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N SIZO <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. to I <br /> O 9 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN W <br /> Cr <br /> NEEDED. <br /> O <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: � 0 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 91 <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. y Zl <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER v <br /> SETBACK AREA. <br /> m = obi m m O m <br /> 6. <br /> < 3 n <br /> N C(on 20 <br /> 0 �+ <br /> 7. Z . Q <br /> o : <br /> =rn : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> n ` C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of 9j a <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize Dii 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- O <br /> r <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 pqrmit county officials charged with administering county ordinances or other m <br /> authorized person to ave access to th ove qpscribed p mises at any reasonable time for the purpose of inspection. T <br /> CD <br /> SIGN HERE 11 <br /> d <br /> (signature oNown r W buil ing contrac _ // ] (date) <br /> J ((33 <br /> ZONING ADMINISTRATOR <br /> cNi o <br /> 0000 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> 0000 <br />