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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator o o <br /> - <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> F .. �' <br /> c C <br /> OWNER �oy ��S TELEPHONE10 Uj <br /> CL <br /> v <br /> HOME ADDRESS l/vD 616-r, �� ssy3i <br /> > > �a� �l�m <br /> ySh3 <br /> Ir <br /> EMERGENCY/FIRE NUMBER ROAD NAME L 14 r s*mg h <br /> LEGAL DESCRIPTION(see tax receipt) <br /> LCi U "'\\ \ <br /> Cn <br /> TYPE OF PERMIT(S):DWELLING/B0 <br /> UILDING GARAGE/ACCESSORY STRUCTURE ADDITION C <br /> c <br /> Cr <br /> CL <br /> 5. <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION to <br /> STRUCTURE/ADDITION USE: <br /> //0 Mf <br /> 6 <br /> (Home/Cabin; Commercial Business;Bedroom; Deck;etc.) <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR 911 <br /> 3. <br /> T <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O C <br /> N <br /> N \ <br /> DIRECTIONS FOR PLOT PLAN DRAWING- (AERIAL OR TOP VIEW) O <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 �1 Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m IF <br /> NORTH(N). y c <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m n 3 <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, w <br /> STREAM OR RIVER. I o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILD- \ <br /> INGS,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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 00 <br /> ISSUED. a <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: Po <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT RJ n <br /> ISSUANCE. N <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY v <br /> PERMITTED. 4 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN 75 FEET OF THE OHWM OF LAKES, \ QJ <br /> PONDS, RIVER U LESS SPECIFICALLY PERMITTED. <br /> 6. liL7�C�YL� � /N C2^2 l l�Cx — TO <br /> ;a -0 <br /> °n' m <br /> ' m c o ' <br /> o.: i x <br /> y. m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of d E C <br /> all information contained in this application(including an accompanyingschedule and I further declare that I recognize m m' m <br /> PP ( 9 Y ) g <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to is- p <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information 1 am ' <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <br /> authorized person to hav,91access to the above de cribed premises at any reasonable time for the purpose of inspection. <br /> SIGN HERE <br /> (signal a of owner or build ontractor) (date) <br /> ZONING ADMINISTRATOR <br /> wwwwwfn� <br /> - N N G1 N N t71 frl <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />