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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS . <br /> r- <br /> 0 <br /> N <br /> C <br /> /� fD <br /> OWNER f / � u� M TELEPHONE o <br /> 4� <br /> m°D t <br /> O <br /> HOME ADDRESS <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) Dy���� <br /> DWELLING/BUILDING GARAGE/ACCES OS RY STRUCTU ER 1:1ADDITION ❑ PRIVY ❑ ^1 Cl) 0 <br /> TYPE OF PERMIT(S): CL <br /> \ G <br /> v <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITION USE: G �JJf��,n��go ° <br /> t (Honie/Cabin Corlrmercial Business; Bedroom; Deck; etc.) U <br /> BUILDING CONTRACTOR: y�� /� ✓'�� w <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 T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> 0 N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n o <br /> 'n O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m ;Ur <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C <br /> NORTH(N). ° <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m B <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF o <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <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 ) <br /> MUST BE SIGNED AND DATED BY THE OWNER. (� ° <br /> p � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE 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 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 SPECIFICALLYPE <br /> / <br /> 4. NO STI UCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATE♦3/ <br /> SETBACK AREA. <br /> 5. 0 < 3 pap m <br /> < 3nm � n = 3_ <br /> 6. Lo m Cy O S <br /> 7. O -n`G A) <br /> - cn : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my C - C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of o A <br /> all information contained in this application(including any accompanyi c le and I further declare that I recognize m C <br /> that this information I am providing will be relied upon by the County o r etermining whether to is- G) <br /> sue a permit. I further accept all liability which may be a result of the u 1 o mation I am <br /> providing in this application. I agree to permit county officials charg d ith a c es or otherCD <br /> authorized person to have access to the above described premises at reasonable time for t p ol Inspection. T <br /> CD <br /> db <br /> c .�-- lac _ 6 <br /> i. <br /> SIGN HERE /n w <br /> s' n re of ow r or building contractor) Uqp oc <br /> ZONING ADMINISTRATOR QVC <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />