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Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator �1 G) o <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> OWNER 1n15 TELEPHONE CL <br /> m <br /> HOME ADDRESS aao� (� <br /> r�(Is, CA- °15�2 X11 <br /> EMERGENCY/FIRE NUMBER I O DL O ROAD NAME I � AM <br /> :�l��) <br /> LEGAL DESCRIPTION(see tax receipt) pd . — SE E _& , ) '3/_ _ � �CJ c <br /> n� CJ m <br /> 1 0 <br /> N <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION � <br /> a <br /> N <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o' <br /> Ca <br /> STRUCTURE/ADDITION USE: clam Vt )�� � 3-7- 13 <br /> m <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. r <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) p m <br /> n a <br /> T 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 ir <br /> NORTH(N). <br /> n <br /> co 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m v <br /> W <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHM)OF LAKE, z <br /> STREAM OR RIVER. o <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. N 1� <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS I <br /> MUST BE SIGNED AND DATED BY THE OWNER. c <br /> r) w <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE to UI <br /> ISSUED. (� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c I i <br /> CONDITIONS OF PERMIT: <br /> O <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT Yl <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 /> MM mm Oo -o <br /> 6. ,SC �ndl-�,a <br /> a ;� 70 <br /> 7. �^ v R C0 0UO3 � <br /> P x <br /> —y : <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of d C <br /> all information contained in this application(including any accompanying schedule)and I further declare that ICLrecognize m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to is- p <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 m E <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m i <br /> m : <br /> m : <br /> SIGN HERE `p <br /> (—siggnna�tuurre of owner orbuildingcontractor) (date) <br /> ZONING ADMINISTRATOR <br /> wwwfwfnCAM <br /> N Ntn N Nf <br /> V7 (TO(T(T 00P <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />