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L <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,W154872 Office of Zoning Administrator - c c <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> _ r <br /> N 0 <br /> OWNER � TELEPHONE o�N Mn,�l�l�e,� � o <br /> HOME ADDRESSz -0 �1e� `� J <br /> r <br /> EMERGENCY/FIRE NUMBER Z 5_0 ROAD NAME �� 1 <br /> LEGAL DESCRIPTION(see tax receipt) I � <br /> y 0 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTUREZtADDITION v <br /> L34 <br /> 5. <br /> N <br /> SANITARY PRIVY FILLING/GRADING ,—�CAM�PING UNIT SUBDIVISION <br /> STRUCTURE/ADDITION USE: I 1�.TI C IV -.4-- y <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) a <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 m t, <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a <br /> O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). N <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m 9 <br /> CENTERLINE OF ROAD, (C) BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, ( Z <br /> STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. P <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. o <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. U3 o <br /> _v, <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE q <br /> ISSUED. 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <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 <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 /> m d�O� c <br /> 6. fD 'O me <br /> � CMW <br /> m 0 � 3 <br /> 7. Pi <br /> = y m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my [j -'r p <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of o I i c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize `C m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in <br /> ketermining whether to is- O <br /> sue a permit. I further accept all liability which may be a re t on this information I am ? m <br /> providing in this application. I agree to permit county off�c I e i e i ty ordinances or other m <br /> authorized person to have access to the described p t bl i r purpose of inspection. -n <br /> m : <br /> SIGN HERE <br /> 998 -Zo-q� <br /> i—'a''tuurree of owner or building coot or) _ (date) <br /> ZONING ADMINISTRATOR J 1.Y1 rI11 of 1 BURNLc ± G�i� TY • • • • • : <br /> Z0q� ' cn fn t»t»t»tn� <br /> ; M!MG (N71 VNI O fNl� 00 O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />