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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator 'No <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> ^ r <br /> N O <br /> OWNER -e� SC71 TELEPHONE 0 S) <br /> HOME ADDRESS - C -1 ,/ Eic_kt0C'.I Ca!(P, <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) 5111�� .7.��f a `-' _ �"1� m <br /> Q <br /> TYPE OF PERMIT(S):DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION cr ' <br /> a �0-- <br /> N <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION X 0 <br /> u1 <br /> N. 1 <br /> STRUCTURE/ADDITION USE: ti I 1 + lU • / — I ao <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m <br /> w <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 n <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 93 �o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). N p) <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO fn T 3 <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER. c <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 0 <br /> tit <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> o 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ° <br /> � <br /> ISSUED. O <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS 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 /> 5. <br /> � 3 n 3F° MX <br /> 6. a 'a cN o r <br /> car) i m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c I p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of n E C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize o m m <br /> that this information 1 am providing will be relied upon by the County of Sumett Wisconsin in determining whether to is- <br /> 23 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 ��/� s, E E <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other E (D <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. -n <br /> CD : <br /> o : <br /> h : <br /> SIGN HERE <br /> (signature of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR I to �It^ ` ' ` ` ` d+ <br /> dJ <br /> 40410h4040 4049 <br /> NNNNK) 0 <br /> N wom (A00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 666 <br /> 0660000 <br />