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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator cr o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> o_NC <br /> rr U <br /> r <br /> CD <br /> TELEPHONE�q r�aoHOME ADDRESS m� <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> + <br /> LEGAL DESCRIPTION(see tax receipt) S E 2 - 39- 1�4 o' <br /> IR- <br /> DWELLING/BUILDING <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE IXJ ADDITION ❑ PRIVY ❑ 0 <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <' <br /> Gara ° <br /> ge - aux N <br /> STRUCTURE/ADDITION USE: <br /> _ <br /> Home/Cabin; Commercial Business; Bedroom; Deck;etc.) oi <br /> U) ti <br /> BUILDING CONTRACTOR: 9-Gt r e Q �! e <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O V� <br /> M m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n n <br /> T <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 n <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 ° <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(OF),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. ` IN <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS 0 /,I`' <br /> MUST BE SIGNED AND DATED BY THE OWNER. ° UJ <br /> O � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN ° C) <br /> NEEDED. X) <br /> I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o Q <br /> CONDITIONS OF PERMIT: <br /> 1 <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 <br /> SETBACK AREA. <br /> 5. <br /> MM- 0 D O D F m <br /> MM <br /> a m O ° M <br /> 6. o m cy N o 3_ <br /> Z N N ° O <br /> 7 O : T <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my A <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of jQ a <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m mo <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <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 9 <br /> providing In this application. I agree to permit count officials charged with administering count ordinances or other <br /> p 9 � pp� 9 Y 9 9 Y � <br /> authorized pe rso to have access to the above described premises at any reasonable time for the purpose of inspection. T <br /> CDm <br /> SIGN HERE <br /> (signature of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR �, I/Yl G�YI l G <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />