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No. Siren,WI 54872 Office of Zoning Administrator -0o 0 <br /> Burnett County 7410 Co. Rd. K, <br /> APPLICATION FOR LAND USE PERMITS y <br /> N <br /> C <br /> (D q <br /> TELEPHONE o <br /> OWNER d <br /> � „ / O <br /> / ///lAJ/ <br /> HOME ADDRESS <br /> Q_ <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> 1 <br /> �W <br /> LEGAL DESCRIPTION (see tax receipt) <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCT RE ❑ M'naPRIV4Y (11 � <br /> TYPE OF PERMIT(S): a <br /> i� - <br /> FILLING/GRADING ❑ CAMPING UNIT SUBDIVISION <br /> C S <br /> 0 <br /> STRUCTURE/ADDITION USE: cn <br /> (Home/Cabin; Comme tial Business; Bedroom;De ; etc.) m <br /> BUILDING CONTRACTOR: i <br /> v <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81A X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> O m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) -n o Z <br /> n m � <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> C n <br /> NORTH(N). TO ALL LOT LINESy 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S) ,(B)BUILDINGS)TO <br /> m 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF oZ <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 GRADED RA ETC.,THE PLANS <br /> FILLED. ? <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, O <br /> MUST BE SIGNED AND DATED BY THE OWNER. p <br /> y O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN I 1 <br /> NEEDED. <br /> Z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> 0 <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT , <br /> ISSUANCE. RICTED C <br /> 2. REMOVAL OR 3. NO GRADING OR HIORELAND ALTERATIONS ARE NG OF TREES AND IOALLOWEDIS TUNLESS SPECIFICALLY LINE. <br /> r1 <br /> PERMITTED. x' <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. m � a�i � cDima m <br /> mK32- <br /> m <br /> 6. � ' V y00j 720 <br /> Z : <br /> 7. o O I <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c . m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuragcy of p ° M <br /> all information contained in this application(including any accompanying schedule)and I further declare that I re nize N <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <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 W <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other I <br /> ibed premises at any reasonable time for the purpose of inspection. - <br /> authorized person to have access to the above descrC <br /> SIGN HERE (date) ) <br /> (si ature If owner or building contractor <br /> 1 <br /> ZONING ADMINISTRATOR Cil <br /> OWNSHIP PERMITS MAY BE REQUIRED <br />