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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 C <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> H 0 L <br /> N \' <br /> /A/ / C <br /> OWNEFOZIrvUp r( ! /�!/C3 /l LO.f--� TELEPHONE m <br /> ft <br /> 41 <br /> HOME ADDRESS��tj lqo X S �j� cizo <br /> CD <br /> �/C ° <br /> EMERGENCY/FIRE NUMBER �5��2 ROAD NAME /`/jj: <br /> LEGAL DESCRIPTION(see tax receipt) { t Sn l ✓/ po-o a_ CD <br /> r ° <br /> c <br /> DWELLING/BUILDING 5� GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ ° <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ 5 <br /> N <br /> STRUCTURE/ADDITION USE: 0 <br /> (Home/Cabin, Commercial Business; Bedroom; Deck;etc.) C0 <br /> BUILDING CONTRACTOR C� 5-1ee(P 1 <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/1 X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. V" <br /> 0 y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 c <br /> T o z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). CO) o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 31 1 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <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. O <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. I <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. o C� <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN Cr ° <br /> ILL <br /> NEEDED. ° <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: <br /> ) <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. 1 <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 lXY' <br /> SETBACK AREA. <br /> 6. (�� m � 3CLCD %� .;0 <br /> v NCe ° 03 <br /> Z <br /> 7. o N <br /> M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my tj c c <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of n L <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 1 O <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 officialsed with administering county ordinances or other m E <br /> authorized person to have access to the above de cribed premie nable time for the purpose of inspection. -n <br /> SIGN HERE <br /> (signature f nor or building c act r) t i (date) <br /> ZONING ADMINISTRATOR ' <br /> RN nM <br /> E N Nnp1 nppp <br /> (T (P O (P U1 O O <br /> NSHIP PERMITS MAY �VjV 0 0 0 0 0 0 0 <br /> G ?? <br />