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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 o oz <br /> APPLICATION FOR LAND USE PERMITS _3 <br /> c <br /> OWNER ,TELEPHONE <br /> v <br /> m <br /> m ...� <br /> HOME ADDRESS <br /> r <br /> EMERGENCY/FIRE NUMBER ' I ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) 1 E " /� "( �, Y i �. ? > + <br /> > - ur <br /> 1 0DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY El C/) 0 <br /> TYPE OF PERMIT(S): Q <br /> FILLING/GRADING IJ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> N <br /> STRUCTURE/ADDITION USE: E ` " 0 hI <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) rn <br /> m <br /> BUILDING CONTRACTOR CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> :0 y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a <br /> 4Lz <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. A �. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m 9nC <br /> NORTH(N). <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 Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 5.Q. o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO I <br /> BUILDINGS,ROADS, LAKE, LOT LINES. 1) O <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS I <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z <br /> CONDITIONS OF PERMIT: <br /> o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 1 <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 Y IJ <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER ,y <br /> SETBACK AREA. p� / �u <br /> 5. n,b III b \ W�-fI zvnr v vv <br /> ! / m m m m <br /> 6. n!U VC l l �v( ti /Co�� ��� �O n N y .� <br /> • m C'M 0 3 <br /> 7. z m N� <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 a <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- v <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. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to the above described remises at any reasonable time for the purpose of inspection. T <br /> CD : <br /> SIGN HER G v •Y/r' G'l_ - L. ( •._,f �,� ..,L & �i cn <br /> ( gnatu of owner or buil ' g ntractor) (date) <br /> ZONING ADMINISTRATOR <br /> N N(J N <br /> TOWNSHIP PERMITS MAY BE REQUIRED in <br /> �f o 0 <br />