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Burnett County 7410 Co. Rd. K, No.1102, Siren,WI 54872 Office of Zoning Administrator -14 o c <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> OWNERf TELEPHONE �g Q - - d <br /> /" //'^' I � � <br /> HOME ADDRESS f �g /y- SytOrc Dc'- r G_ 'rGYI�5 6 y rs W i �`{8`f a r <br /> u q r l <br /> EMERGENCY/FIRE NUMBER I t lz, I ROAD NAME �qrt� Shire L�r- <br /> 1 r \ <br /> LEGAL DESCRIPTION(see tax receipt) <br /> TYPE OF PERMIT(S):DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE----ADDITION- <br /> Cr <br /> 5. <br /> 0. <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> y <br /> STRUCTURE/ADDITION USE: buy � d �cc.(C G'^� a� � cn Q <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) IV <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -� <br /> a O <br /> DIRECTIONS FAR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 $ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. ;b <br /> M 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE M n <br /> NORTH(N). H ° <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m a <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <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. Q� <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 1 <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. to <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE <br /> ISSUED. 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: i o� <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 /> ;a -umr v�vm <br /> 6. '_� www;MN <br /> 7. o : w91 '2 1 <br /> __0) <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my Zf c m <br /> A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of c`�' c <br /> all information contained in this application(Including any accompanying schedule)and I further declare that I recognize ' m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m '• v <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 m ; <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. n <br /> _._ . m <br /> SIGN HERE <br /> a re of ow orb ilding contractor) 1 T (date) <br /> ZONING ADMINISTRATOR l Im 4040 fA a 40 <br /> IIV N .fNJ1 N NNOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED' t` '� 0 0 0 0 0 0 0 <br />