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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 G) Z <br /> 5. <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> N 0 �I <br /> OWNER L S \ �/ TELEPHONE <br /> HOME ADDRESS p �C <br /> h O <br /> t� 1 <br /> EMERGENCY/FIRE NUMBER oZF�� / ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) L13 �/✓>° UUU �7 �j I Cn <br /> i�C s !o�/ -4M ��6 <br /> e <br /> DWELLING/BUILDING 0 GARAGE/ACCESSORY STRUCTURE DDITION ❑ PRIVY ❑ N G <br /> TYPE OF PERMIT(S): `v <br /> FILLING/GRADING CAMPING UNIT ❑ SUBDIVISION ❑ L1 <br /> S. <br /> STRUCTURE/ADDITION USE: �/ rt <br /> (Home/Cabin; CommercialBusiness; Bedroom; Deck; etc.) 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 OR � 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> (AERIAL OR TOP VIEW) 0 o <br /> Z <br /> ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. t7 m z <br /> SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C ° <br /> n: <br /> NORTH(N). W o <br /> 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. I o <br /> SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO <br /> BUILDINGS,ROADS,LAKE, LOT LINES. <br /> INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. ro 00 <br /> O 9 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN Cr ° <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P O <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT Q <br /> ISSUANCE. I� ' <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. i 1V <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 /> G W O O m <br /> 10 <br /> G) • d � � � m <br /> 6. 9 m c y 3 <br /> 7. o <br /> = ur: m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of p` c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize <br /> vi m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- O <br /> sue a permit. 1 further accept all liability which may be a result of the County of Burnett relying on this information I am <br /> providing in this appl' on. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to ave acc ss tot above described prejVises at any reasonable time for the purppse of inspection. m <br /> m : <br /> Sm : <br /> SIGN HERE g <br /> (signs re ol owner di contractor) (date) <br /> ZONING ADMINISTRATOR U� <br /> ri <br /> w 0 N <br /> to Fn CA <br /> N N (11 NUI <br /> (P Ut O NOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0o 0 c 00 <br />