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Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS <br /> a0�( Br 74�e�- f� 6/ 2. w s <br /> 'T1 N d 3� <br /> y s- <br /> �► I1� �d 33 <br /> OWNER � o)jpij - 5( Syz_AK n o �Jf7P_bAo �ELEPHONE ��S Q/�[n o <br /> HOME ADDRESS 2-79u?, C.O(9WT- 4 Tab <br /> EMERGENCY/FIRE NUMBER Z7 g(oZ CO►JF�I`f Q� �� ROADNAME CrA)KIT-t --z-- .. <br /> LEGAL DESCRIPTION(see tax receipt) P[ <br /> / I c <br /> // of <br /> TYPE OF PERMIT(S):DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION YU c <br /> Q: <br /> 5. <br /> LA: <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0� h , <br /> cn[ _ ` E <br /> STRUCTURE/ADDITION USE: f t'�.1Yt I y B W� f Er <br /> (Home/Ca in;Commercial Business; Bedroom;Deck;etc.) a <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR m <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) C <br /> n <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 <br /> NORTH(N). y <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, ZQ <br /> STREAM OR RIVER. °\S_ <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. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS C'N <br /> MUST BE SIGNED AND DATED BY THE OWNER. m c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 3 ! <br /> ISSUED. St ^� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <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. 1 <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 <br /> /UNLESS SPECIFICALLY PERMITTED. <br /> ,/ UtI� I�JC��17y d V T X v 0 r �pj go�v -0 <br /> 6. <br /> (/A a Cm o SC <br /> 7. of w1°� 1O1 <br /> Cn m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of n Er <br /> all information contained In this application(Including any accompanying schedule)and I further declare that I recognize e m : m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- y 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 d <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other to s <br /> authorized person to havpAccess to thA above described premises at any reasonable time for the purpose of Inspection. <br /> - <br /> SIGN HE W <br /> (sia re o er or building contractor (date) <br /> ZONING ADMINISTRATOR h <br /> • fR fR to H N -� <br /> 77 f7i f7i O f7i tT , O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 1 �V iE d 00000 0 <br />