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Burnett County 7410 Co. Rd. K, No. '102, Siren,WI 54872 Office of Zoning Administrator TI o 0 <br /> APPLICATION FOR LAND USE PERMITS CL <br /> w <br /> OWNEit �i� ( ` c <br /> V � � � d `� � TELEPHONE Z� / L, L',L' a <br /> "VA m C. <br /> � O <br /> HOME ADDRESS , <br /> r <br /> o <br /> EMERGENCY/FIRE NUMBER POAD NAME <br /> i 15>7,77574 <br /> LEGAL DESCRIPTION(see tax receipt) 6�O{' <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTUREADDITION <br /> n <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o.� <br /> STRUCTURE/ADDITION USE: `—�/y"� � C� r` lQ 1 6r 6A <br /> 1 <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) v <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. In C <br /> ^' <br /> 0 a <br /> x N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O <br /> :0 Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m S ` <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). y o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <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. <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. o <br /> o � � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE a ° QJ <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c � ' <br /> CONDITIONS OF PERMIT: i <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. j qq <br /> m <br /> 7. c : w �� �m <br /> =N 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 C ` C <br /> CL ;a <br /> all Information contained in this application(including any accompanying schedule)and I further declare that I recognize mm <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- O <br /> m : <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 <br /> providing in this apliwation. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized pereong have accesq to th bov cribed premises at any reasonable time ose of inspection. m i <br /> SIGN HERE <br /> (sign ure owner or building contractor) (�T(d7ate) <br /> MIT <br /> ZONING ADMINISTRATOR t I 0"' f 0 �n <br /> h H h H un <br /> ! N N N Cn CT <br /> 6 CTO OO <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 <br /> . .. - - <br />