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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrato o 0 <br /> APPLICATION FOR LAND USE PERMITS 4 <br /> ir <br /> w <br /> OWNER TELEPHONE <br /> O . � <br /> m <br /> HOME ADDRESS <br /> r <br /> EMERGENCY/FIRE NUMBER ROAD NAME (� <br /> n, C) <br /> LEGAL DESCRIPTION(see tax receipt) y— P� XJ m <br /> i� <br /> Q <br /> y 0 <br /> TYPE OF PERMIT(S):DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE DDITION i a <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> U`J N <br /> m <br /> STRUCTURE/ADDITION USE: 6 <br /> (Home/Cabin;Commercial Business; a oom;Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> x G <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. g �A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE M t) <br /> 3. SOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m a <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z C <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. 64 <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. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: C <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. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY © I <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 /> Phis structure to be used as private residential z � ; o L o m <br /> 6. garage/storage only. Not to be used for human , 3 21 i; . <br /> so <br /> habitation. i a m q :' <br /> 7. P ca i im <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c i i E A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of a` S <br /> all information contained In this application(including any accompanying schedule)and I further declare that I recognize '� W m m <br /> that this information I am providing will be relied upon by the County,of Burnett Wisconsin in determining whether to is- di i O <br /> sue a permit. I further accept all liability which may be a result of, udty of purnett relying on this Information I am d <br /> providing in this application. agree t ermit county offs als char e i Bring county ordinances or other E m E <br /> authorized person to have a ce to th a ve d cribed pr mixes at any reale a for the purpose of inspection. n <br /> m : <br /> SIGN HERE <br /> r t 9 /n-(�-��9C� <br /> (sig-n�re of owpne�r or building conte R'vF / (date) <br /> ZONING ADMINISTRATOR V►r(� 1'L�ry�(X�t1 'YC� r <br /> �+ <br /> NMM MEAN <br /> ^ N Nnp NN pp <br /> U U I N O U 1 f l� O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />