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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator v 0 Z <br /> APPLICATION FOR LAND USE PERMITS 3 i/� Aj'' <br /> a �\ �L J <br /> OWNER ^ esTELEPHONE <br /> c� (ay_")'>h � lo�b' <br /> IaS o N o <br /> 0 <br /> HOME ADDRESS . _ — 9 <br /> 01 <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> Sim / �� I� : a ciC�e5 <br /> LEGAL DESCRIPTION(see tax receipt) t 7 / I _ _ ( ` r —� <br /> y <br /> TYPE OF PERMIT(S): DWELLING/BUILDING_A GARAGE/ACCESSORY STRUCTURE X nDDITION <br /> E. <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> m <br /> �dr2. <br /> STRUCTURE/ADDITION USE: �.v��e � � or <br /> (Home/Cabin;Commercial Business;Be oom;Deck;etc.) � <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR .n 3 C <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> I� N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 <br /> T 0 Z <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 <br /> NORTH(N). rcc c <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <br /> a <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER. P <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILD- W <br /> INGS,ROADS,LAKE,LOT LINES. sj <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 'I� <br /> MUST BE SIGNED AND DATED BY THE OWNER. o V ` <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE cr <br /> ISSUED. 2 <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 /> z3. 0W= pvc� �ore <br /> oo. m � 3Fg' m <br /> Io �` 3 C oe' <br /> 6. a vC� e, <br /> Nmo : Zia <br /> Z : m <br /> 7. m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of iny c iD <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofa ' C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize o rn : m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m '• v <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 <br /> providing in this application. I agree to permit county officiaij charged with administering county ordinances or other m <br /> authorized person to have access above described prerffises at any reasonable ti ns ion. n <br /> SIGN HERE? <br /> 17, <br /> ` E <br /> 21� <br /> (sign atu oT owner or building contractor) '/(1al W <br /> t.7JI <br /> i t 1 t i � ' <br /> ZONING ADMINISTRATOR . w H H <br /> ooc o <br /> TOWNSHIP PERMITS MAY BE REQUIRED _..__ 00 0 0 <br /> W)C-Seo-T <br />