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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 <br /> y O <br /> N <br /> C <br /> ID <br /> / n <br /> OWNER Z TELEPHONE o <br /> Og/HOME ADDRESS r � <br /> 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> W—/7 Cl— S m <br /> LEGAL DESCRIPTION(see tax receipt) `° <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ <br /> Cr <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAIv1WNG UNIT ❑ SUBDIVISION <br /> O <br /> STRUCTURE/ADDITION USE: Xv /S rn <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) <br /> w <br /> BUILDING CONTRACTOR: { <br /> CD <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR TO 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. N <br /> c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n Zm <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> NORTH(N). y <br /> m <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF Zo <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. N <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 /> MUST BE SIGNED AND DATED BY THE OWNER. p ped <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN <br /> 1 <br /> NEEDED. <br /> Z \� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <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. I w <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 � unido (Daaf m <br /> 3 a 2 2. W <br /> 6. Z N 0 o 3 <br /> O n m <br /> 7WESM — �' A <br /> lication mcludin an accom an in schedule) has been examined by me and to the best of my 0 C <br /> that this app ( 9 Y P Y 9e and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of mation contained in this application(including any accompanying schedule)and I further declare that I recognize Minformation I am providing will be relied upon by the County of Burnett Wisconsin ii determining whether to mG) : <br /> rmit. I further accept all liability which may be a result of the County of Burnett relying nt this information I heg in this application. I agree to permit county officials charged with administering county ordinances or other <br /> d person to have access to the above described premises at any reasonable time for the purpose of inspection. m : :. <br /> CD : <br /> r» <br /> SIGN HERE (date) <br /> (signatureo er or building contracto <br /> ZONING ADMINISTRATOR ` <br /> TOW SHIP PERMITS MAY BE REQUIRED <br />