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Burnett County 7410 Co. Rd.K, No. 102,Siren,W154872 Office of Zoning Administrator � u <br /> APPLICATION FOR LAND USE PERMITS 3 0Du <br /> N r� 11 <br /> OWNER ::3t%r6 TELEPHONE Y3-3 <br /> n JC l j� m 0 <br /> HOME ADDRESS ��j �1�/moi✓ S�, �r �� ��I`J �a r g <br /> pn <br /> EMERGENCY/FIRE NUMBER ROAD NAME ���� /C�/ <br /> r <br /> LEGAL DESCRIPTION(see tax receipt) <br /> v <br /> o <br /> TYPE OF PERMIT(S):DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION a <br /> / e: Ep <br /> SANITARY PRIVY`r FILLING/GRADING CAMPING UNIT SUBDIVISION N <br /> � ) X <br /> STRUCTURE/ADDITION USE: � <br /> (Home/Cabin;C mmercial Business;Bedroom;Deck;etc.) <br /> 3 <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR O <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. y c <br /> niRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) A 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 C o <br /> NORTH(N). fn <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDINGS)TO m 10 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, 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. <br /> --16. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLA 2. o <br /> MUST BE SIGNED AND DATED BY THE OWNER. p <br /> S <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE Cr <br /> ISSUED. ) <br /> z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o C�) <br /> Cnuninnus OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT N <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 /> M 'DOm 0 <br /> 5. M <br /> 6. ^ ` wwo '" �m ; <br /> Z <br /> i � A <br /> 7. =coE I m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Gf C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofDO i m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize a5: ? c <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this Information 1 am <br /> m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other UN 1 1 m : `• <br /> authorized person have access to the above described pre as at any reasonable time for the purpose of inspection. Co <br /> - , <br /> SIGN HERE (date) ^' <br /> (signature of own or building con actor) <br /> ZONING AD <br /> IN RA JLn `p fe fe ie`a <br /> N N(TNN(T � <br /> un NOul fT00 <br /> 0 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED O 0 0 0 <br /> �6vy r� xA ,�I 67 <br />