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Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator a o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> OWNER TELEPHONE <br /> HOME ADDRESS <br /> CJ0 r <br /> —7 0 . <br /> L ( . <br /> EMERGENCY/FIRE NUMBER 1S / ROAD NAME �U`Z2,4e <br /> LEGAL DESCRIPTION(see tax receipt) kr� 3 0_5/ G/ -Z P4-5q ` G 2a' m Lj-3946 _5v,rp�t v. ��� 9 <br /> w <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTUREADDITION eT <br /> Q <br /> 5. <br /> w <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> N <br /> N <br /> �f <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR 3 C <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. G <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) 0 <br /> ?� 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 <br /> NORTH(N). C O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO tyrr �` 93 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)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- Cy <br /> INGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. d N <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. <br /> o 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BEEr. o, <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o (� <br /> CONDITIONS OF PERMIT: <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. J <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 PECIFICALLY PERMITTED. 1 �^, 0 // �//����, <br /> �. cSAN p�fjyi✓t�b 6e- <br /> 5. S h�✓'L �tiSirfe t.I w Anow-e <br /> (� z v� 0 rd 0 <br /> v V <br /> 6. S�5 im is jAiST�t4* 03 a ;MV 9 <br /> 7. /Vat a' : H Na i <br /> ic <br /> O <br /> SIN: i <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Z)or C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of go <br /> all Information contained in this application(including any accompanying schedule)and I further declare that I recognize �a <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m 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 ' m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other CD <br /> 3 <br /> authorized person to have access to the above described premises at any reasonable n <br /> H <br /> SIGN HERE <br /> na roof owns r uiiding contractor) ..(datqL <br /> :!1 i i <br /> ZONING ADMINISTRATOR �` '• ` E N <br /> fA 104044 M <br /> NNN 01 <br /> TOWNSHIP PERMITS MAYBE REQUIRE J o 0 0 0 0D0 <br />