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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 2 0 <br /> APPLICATION FOR LAND USE PERMITS 3 4 <br /> r <br /> 0 <br /> OWNER I� TELEPHONE -7-77-04113 <br /> a <br /> HOME ADDRESS f a{ 3 K e � � �I r "a m �� Y Z 9 <br /> r m <br /> 0 <br /> EMERGENCY/FIRE NUMBER " 3 ROAD NAME Vp l f ow (?we1. RCI, 1 ~ <br /> LEGAL DESCRIPTION(see tax receipt) �-r 1(o 1 0 r1ura'C <br /> e <br /> CO Q <br /> TYPE OF PERMIT(S):DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTUREADDITION c <br /> CL <br /> 5. <br /> a <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;CommeMdl Business;Bedroom;Deck;etc.) y <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p ' <br /> w <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. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C .. n <br /> NORTH(N). N '0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m �' 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, <br /> STREAM OR RIVER. <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. N <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. m o W <br /> o i <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE " <br /> 1 <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: <br /> VIJ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. (�J <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN 75 FEET OF THE OHWM OF LAKES, <br /> PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. <br /> A -0 m m t7 L <br /> 6. � 3nn ; <br /> 7. o � <br /> -ca m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my g p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of n S <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize o e 1 <br /> M <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- O <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 m <br /> providing in this application. I agree to permit county officials charged with administerin county ordinances or other m <br /> authorized person to h a ess to the above described premises at any reasonabl a ,pettP -n i <br /> SIGN HEREOV <br /> 7 Cf <br /> (s natu ofner�Ingcontractor) } rnf I l i 2 (QatW„1h6 <br /> ZONING ADMINISTRATOR40! CH H H H H w <br /> / ... . ,fN7i fNnON,6Nn 00 <br /> TOWNSHIP PERMITS MAY BE REQUIR L 0 0 0 0 0 0 0 <br />