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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator U 0 '�Z� <br /> APPLICATION FOR LAND USE PERMITS . �% (A <br /> r <br /> w » <br /> OWNER I ll`��'-rL 4 W d V IIP L.1 5- a TELEPHONE <br /> d <br /> HOME ADDRESS l oI Lj' � .t- �� �(� ,^ �I /(�� J <br /> O <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> 0 <br /> LEGAL DESCRIPTION(see tax receipt) 0 <br /> -se <br /> Ce <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION cr ' <br /> Q <br /> a' Q <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 CJ <br /> STRUCTURE/ADDITION USE: <br /> ism V, Is p , 12q _ 05 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) Q 1 <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> 3, <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T _ 97) <br /> DIRECTIONS FOR PLOT P 6N DRAWING7 (AERIAL OR TOP VIEW) p <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 r_ n <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO M ` 3 <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- <br /> INGS, ROADS, LAKE, LOT LINES. OX <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N i <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. 5. c <br /> v � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 5 <br /> ISSUED. C� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z <br /> Ca <br /> CONDITIONS OF PERMIT: P <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 1 <br /> ISSUANCE. ( 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. (vN <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 20 0 -0 <br /> 6. � y a w I ;M0 <br /> ema <br /> 0 to <br /> 7. 0 wiz : .� <br /> o _ <br /> I declare that this application (including an accompanying —uJ' ' m <br /> pp ( g y panying schedule) has been examined by me and to the best of my �'• p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m I '• C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize B E m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Is- (Jl m 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 d <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 <br /> -ni <br /> m : <br /> e : <br /> SIGN HERE <br /> N : <br /> (signature of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR I(Yl <br /> N N N N N 0 <br /> p pN NO�fn <br /> N ONS f1i00 <br /> K!1� <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 <br />