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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 7 eon� o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> _ r <br /> CL <br /> v N � <br /> C <br /> OWNER L TELEPHONE <br /> HOME ADDRESS O U Lh 96 h 114 V(A Al?e lL Lf, C A41- <br /> r <br /> 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME RlrC)k�nh <br /> LEGAL DESCRIPTION(see tax receipt) 9:v <br /> rI <br /> ` y o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE-ADDITION— <br /> CL <br /> TRUCTURE ADDITIONn <br /> N ' <br /> SANITARY PRIVY FILLIN <br /> G/ <br /> GRADINGCAMPING UNIT ,t SUBDIVISION 0 <br /> STRUCTURE/ADDITION USE: 4,0 lee., /Y/Q D/7 <br /> (Home/Cab ; Commercial Business; Bedroom; Deck; etc.) <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR m '3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> x in <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a <br /> _n o z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m mir <br /> n <br /> NORTH(N). to o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m (]O <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, z <br /> STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. ? , <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 ) <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE Cr 0 k_) <br /> ISSUED. 2 i <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z I� <br /> CONDITIONS OF PERMIT: P i <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT W <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, 1 <br /> PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. <br /> a vM? CD m <br /> m <br /> 7. o : <br /> l c) m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 't c p <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 1 recognize m m ;a <br /> m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 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. 1 agree to permit county officials charged with administering county ordinances or other m <br /> authorized person have access to the above described premises at any reasonable time for the purpose of inspection. -n <br /> CD <br /> CD : <br /> SIGN HERE <br /> (signature of o ner or building -o frac or) (date) <br /> ZONING ADMINISTRATOR '. • • • • . F» <br /> N N (nNN (IIN <br /> fT (lO Cil (n O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />