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i 7 <br /> Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator "D ° Z <br /> APPLICATION FOR LAND USE PERMITS <br /> o (� <br /> ig <br /> OWNER 7"Tf- TELEPHONE �js� 6, � m <br /> HOME ADDRESS 7 C 1..6u M AKE86 86 9V g <br /> EMERGENCY/FIRE NUMBER 7 719 ROAD NAME f O U SJd )_,q&F Pt, <br /> LEGAL DESCRIPTION(see tax receipt) <br /> 33 1 - y <br /> 0 <br /> m � <br /> TYPE OF PERMIT(S):DWELLING/BUILDING����� ���yy�-GARAGE/ACCESSORY STRUCTURE ADDITION Cr <br /> N \ I <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR C 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. y 0 <br /> DIRECTIONS FOR PLOT PI AN DRAWING' (AERIAL OR TOP VIEW) A o z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C c <br /> NORTH(N). ALL m 3 <br /> 3 CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TOT ESHOW DIMENSINS IN FEET OF THE FOLLOWING: (A) (ORDINARY HIGH WATER MARKI(OHWM OF LAKE, 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. 1 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS c <br /> MUST BE SIGNED AND DATED BY THE OWNER. E. <br /> p <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE n S r <br /> ISSUED. W <br /> Z � <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: <br /> I V1 ) <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. <br /> CUTTING2. REMOVAL OR TREES VEGETATION RESTRICTED <br /> 3. NO GRADING OR SHORELAND ALTERATIONS AREALLOWEDUNLESS S EC F CALRY LINE. <br /> PERMITTED. <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN 75 FEET OF THE OHWM OF LAKE <br /> PONDS,RIVER UNLESS SPECIFICALLY PERMITTED. <br /> � �om <br /> 5. 3 c a M. <br /> 6. v ' mc� N 'fO ; <br /> 7. =Cl) m <br /> io <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my ZS <br /> sponsible for the detail and accuracy of <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am rem <br /> in <br /> er <br /> all information contained in this application(including any accompanying schedule)and I n In determining whether to declare that I recognize t7 <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsm <br /> y <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relyi deng on this information I am ; <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. <br /> 7- 7- 97 w ; <br /> SIGN HERE (date) <br /> (si�of owner or building contractor) <br /> 40 <br /> ZONING ADMINISTRATOR h I11 n N Ni H <br /> N <br /> N N N � <br /> Vt Vl O fT U1 O O <br /> 0 0 0 0 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />