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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> 'APPLICATION FOR LAND USE PERMITS 3. T <br /> N <br /> T <br /> N <br /> C <br /> OWNER TELEPHONE <br /> CD <br /> HOME ADDRESS f <br /> oCD <br /> EMERGENCY/FIRE NUMBER rs ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) ��� /✓ t>� S � co <br /> ,mac. <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE 4L>ADDITION ❑ PRIVY ❑ .' N <br /> TYPE OF PERMIT(S): <br /> Q <br /> FILLING/GRADI CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: _�'� C�/�/// �C <br /> (Home/C In; mercial Business; Bedroom; Deck;etc.) r� <br /> m <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 ORm 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> �l N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <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 m S <br /> NORTH(N). y 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 I I o <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 91 <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO CD <br /> BUILDINGS, ROADS, LAKE, LOT LINES. I (� <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N 90 <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 /> V Q <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN ° <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMI , <br /> ISSUANCE. t <br /> 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORE �5 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY /1 <br /> PERMITTED. ��v 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIR�(G�IAT R <br /> SETBACK AREA. ��// CC <br /> C)d DDF m <br /> 5. <br /> NTNG Nn, 3 a 0, 00 m <br /> 6. O CDC: <br /> N N <br /> 7. O Tom : M <br /> - �: m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G) A <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of a » i i A <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize mi 0 <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 count officials charged with administering count ordinances or other ° <br /> P 9 � PP� 9 P Y 9 9 Y <br /> authorized pens ave cess tot above described premises at any reasonable time for the purpose of inspection. T <br /> m : <br /> CD <br /> SIGN HERE <br /> p , o <br /> (signaturW owner or building contractor) (date) <br /> ZONING ADMINISTRATOR V/ <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />