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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 0 o <br /> APPLICATION FOR LAND USE PERMITS <br /> a <br /> qrs'- G 3S-X721 ` <br /> OWNER � TELEPHONE �rz-88/���58 0 <br /> d <br /> o <br /> HOME ADDRESS /Z-/ / o tdngx1 Z AA4E VaQAleC k , /f✓/ . J!' ��/ 9 <br /> Y w � <br /> EMERGENCY/FIRE NUMBER &k IM ROAD NAME &),wD <br /> LEGAL DESCRIPTION(see tax receipt)Lz S '1H IAS llcdorc W <br /> N <br /> TYPE OF PERMIT(S):DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE DDITION `c <br /> n <br /> 5. <br /> SANITARY PRIVY �+ FILLING/GRADING CAMPING UNITlU ��SffU(jBDIVISIONo <br /> ca <br /> ( DrLSTRUCTURE/ADDITION USE: OP100 /4 <br /> 'g <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR T <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) <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). W 3 <br /> 3. SHOW 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 <br /> STREAM OR RIVER. ( 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. I N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS co V <br /> MUST BE SIGNED AND DATED BY THE OWNER. m o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 0 0 <br /> o <br /> ISSUED. SL <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT '" <br /> ISSUANCE. O ( 6 <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 /> z - mm 0 0 .0 <br /> 6. 3 a n m <br /> Co5* 3 <br /> 7. <br /> o <br /> =rn: m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my C <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of n <br /> all Information contained in this application(Including any accompanying schedule)and I further declare that I recognize m mm <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m 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' i <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized persSm4q have access t the above described premises at any reasonable time for the purpose of inspection. T <br /> ig <br /> ^ H <br /> SIGN HER . . <br /> ( n re of owner uilding contractor) ---�(datef— <br /> ZONING ADMINISTRATOR d ' H <br /> fANNHdIN� <br /> N N r J 1 N N 01 L" <br /> N NON V 1 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRECILhi <br />