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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -V o a <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> u O0 <br /> N <br /> C <br /> (D <br /> O. <br /> tHOME <br /> TELEPHONE ^p e <br /> m <br /> DDRESS v U <br /> 3 <br /> r � <br /> 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> ] I � <br /> /— C <br /> L.� <br /> LEGAL DESCRIPTION (see tax receipt) 3 —�� 1 N <br /> rte <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STR CTU E ❑ ADDITIO UI P,/ <br /> RIVY U <br /> TYPE OF PERMIT(S): Cr <br /> FILLING/GRADING El CAMG UNIT ❑ SUBDIVISION1 / a /,/�'� T R <br /> 0ki <br /> STRUCTURE/ADDITION USE: ' <br /> ( ome/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> R = <br /> BUILDING CONTRACTOR: <br /> M <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/n X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n 3 _ <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O urt� <br /> M N O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> n <br /> -n O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C o <br /> NORTH(N). 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO rn 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. o <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. <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. <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN <br /> o <br /> NEEDED. UfW <br /> Z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. � <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. O� <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. 0(DO a: m <br /> CD <br /> n < <br /> m= 80o. o <br /> o < 3n <br /> 6. o NC3 <br /> 00N a _ <br /> - <br /> N N O <br /> 7. Cn . <br /> ° <br /> In m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my p G> E C <br /> knowledge and belief it is true, correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of m 0 m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize p <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- I <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 /> m : <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or otherCD <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. - <br /> CDCD <br /> Fn <br /> SIGN HERE (date) <br /> (signature of ow wilding contractor) A ,q % <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />