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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 O Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> 57 0 <br /> (1� <br /> OWNER TELEPHONES t/���30y o <br /> Y <br /> m <br /> HOME ADDRESS LATE 15"0 AIV6 N t#kg 6LR10 )W O <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) 0#04n ?�t�cNti' ws� l6 W r49?r4V " �I V 1 <br /> DWELLING/BUILDING D GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ ' !/> <br /> o <br /> TYPE OF PERMIT(S): Q <br /> FILLING/GRADING ❑ CAMPING UNIT W SUBDIVISION ❑ O <br /> �u gaol ` <br /> N <br /> STRUCTURE/ADDITION USE: CIC/ ;147 <br /> (Hom /Cabin; omaBusiness; Bedroom; Deck; c.) <br /> m <br /> BUILDING CONTRACTOR: m <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 1 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. n - <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C 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 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 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> O � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: ts <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 S <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFI S� <br /> PERMITTED. i <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, TC.,ALLOWED WITHIN T EQUIRED �% Z <br /> 6 SETBACK AREA. `�j fD �� <br /> OF 7v) 9. -= <br /> � m <br /> o 1 0 aaDO <br /> m <br /> m6. <br /> 7. CO U <br /> NN ° � 3m <br /> A <br /> I declare that this application (including any accompanying schedule) has been examined by me anrto the best of my G)c' C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m c <br /> r <br /> me IA <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize T <br /> � t7 <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 <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 above described premises at any reasonable time for the purpose of inspection. (D <br /> LT- <br /> -n ' <br /> // m : <br /> SIGN HERE nA <br /> (Irg nature of owner or building co ac dat <br /> �$ <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PER ITS MAY BE REQUIRED <br />