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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator CD o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> y O <br /> H <br /> CD <br /> C <br /> O JER TELEPHONE <br /> �? <br /> HOME ADDRESAU <br /> r- <br /> EMERGENCY/FIRE NUMBER ROAD NAME Y c <br /> ' I <br /> LEGAL DESCRIPTION (see tax receipt) 4-L /�-;�$—tg <br /> f CD <br /> a <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ 0 <br /> Cr <br /> TYPE OF PERMIT(S): <br /> _ <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBD VISI N� ^ <br /> 0 <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business; Bedroom, Deck,etc.) oy, <br /> BUILDING CONTRACTOR: <br /> v <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. y <br /> C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n o- <br /> -n 0 Z <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 o <br /> NORTH(N). W <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 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. o <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 2. <br /> o <br /> MUST BE SIGNED AND DATED BY THE OWNER. o 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN <br /> Ct <br /> NEEDED. <br /> Z _r <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. ° 1� <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT � <br /> ISSUANCE. ( 1 <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. m - and c�u � m <br /> m � 3arocx, :0 <br /> B. a N NN O N 3 <br /> O 1< I� <br /> 7. =Cn m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my L7 2 C <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of x <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize L7 m <br /> ; m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m <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 [ m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other E m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m , <br /> m : <br /> SIGN HERE (date) <br /> (signatur of wrier or building con"51orl i <br /> ZONING ADMINISTRATOR i <br /> UNi CnIn INOO <br /> O 0 0 0 0 0 0 <br /> T NSHIP PERMITS MAY BE REQUIRED <br />