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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 3. <br /> r <br /> rn o <br /> OWNER TELEPHONE <br /> +..r <br /> HOME ADDRESS �/� � �ra�✓%Y �� � /�hi��2� �_� <br /> w ( m <br /> g <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) L / — L/Q— �J� C\ m <br /> a <br /> �iT <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE LJ ADDITION ❑ PRIVY ❑ fn 0 <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADINGG��❑ CAMPING UNIT ❑ SUBDIVISION ❑ y; <br /> STRUCTURE/ADDITION USE: V`Q� c;24 x'=�L o <br /> (H /Cabin; Commercial Business; Bedroom, Deck;etc.) Cn <br /> BUILDING CONTRACTOR: 7K dC 7 /dam -5-, <br /> v <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. 0 <br /> x in O <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. m v A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE 19 <br /> NORTH(N). W 3 <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 <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. c <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 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. ,0 0 <br /> v � � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q <br /> NEEDED. 0 p <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> 0 <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT O <br /> ISSUANCE. Q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY 1�p p <br /> PERMITTED. JJ <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER O <br /> SETBACK AREA. <br /> 5. <br /> m <br /> fo O fO <br /> 7. P <br /> rn <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Lj c p <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy ofo C <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- y 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 <br /> providing in this application. 1 agree to permit county officials charged with administering county ordinances or other Co <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. -n <br /> CD : <br /> m <br /> SIGN HERE Q?� <br /> (signature w bu' c <br /> (date) <br /> �J 1(JV� <br /> ZONING ADMINISTRATOR . . . . w <br /> �nf»fn drww� <br /> N NOt NN Vt <br /> fT M <br /> N 0 VI VI 0 0 <br /> OWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />