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Burnett County 7410 Co. Rd. K, No.102, Siren,WI 54872 Office of Zoning Administrator 4 0 <br /> APPLICATION FOR LAND USE PERMITS r <br /> F 0 <br /> N <br /> C <br /> OWNER <br /> TELEPHONE -�— a <br /> HOME ADDRESS tit, ��, '"�-- r <br /> 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> 1 r Q <br /> AFI- Il. <br /> LEGAL DESCRIPTION(see tax receipt) <br /> v. <br /> — y o <br /> TYPE OF PERMIT(S):DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION a <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> yr <br /> y <br /> STRUCTURE/ADDITION USE: " e I �� O — 9.O <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR .n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. ; w <br /> c <br /> DIRECTIONS Fog pi OT PLAN DRAWING: (AERIAL OR TOP VIEW) Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m a <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE N e <br /> NORTH(N). <br /> 3 CEN ERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TOT E(S)TO ALL LOT LINES, )ORDINARY HIGH WATER MARKIm <br /> SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) (OHWM)OF LAKE, p <br /> Z <br /> 0 <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. 64 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 0 c , <br /> MUST BE SIGNED AND DATED BY THE OWNER. p Q) <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE <br /> ISSUED. <br /> z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: l <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. 0 ,9 o0i r qO m <br /> =CL <br /> 6. o ,m3 <br /> Z : <br /> 7. =rn: 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 <br /> all Information contained In this application(including any accompanying schedule)and I further declare that 1 recognize ; C <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <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 application. I agree to permit county officials charged with administering county ordinances or other E '. <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. -n <br /> e : <br /> e : <br /> SIGN HERE (date) <br /> (signature of owner or building contractor) <br /> i i i i i <br /> ZONING ADMINISTRATOR H w N H H N <br /> N N L" N N f 11 En <br /> N V•ONfT OO <br /> 00 00000 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />