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Burnett County 7410 Co. Rd. K, No.102, Siren,WI 54872 Office of Zoning Administrator - 0 0 <br /> APPLICATION FOR LAND USE PERMITS a 4 <br /> r <br /> �+ o <br /> OWNER f/ 7/ TELEPHONE <br /> v <br /> m <br /> HOME ADDRESS <br /> $ O <br /> EMERGENCY/FIRE NUMBER ROAD NAME _5;1-/Vb dke— koCU <br /> �I\ <br /> LEGAL DESCRIPTION(see tax receipt) �'.f(„r �� {� Szq relo N I <br /> R/S-yJ � <br /> Q <br /> N 3 <br /> TYPE OF PERMIT(S):DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION `r <br /> CL <br /> w <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION � 9j _ <br /> �.,.STRUCTURE/ADDITION USE: � <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) 4 <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. Q_n <br /> A w <br /> DIRECTIONS FOR PLOT PLAN DRAWING• (AERIAL OR TOP VIEW) p <br /> T <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). <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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS L4 <br /> MUST BE SIGNED AND DATED BY THE OWNER. m c t� <br /> q Q� <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE '" o <br /> ISSUED. QI <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 1 <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 /> ill, <br /> / /�/U O�StG1r'1 OYV /_ Ie !? ru"�` S / 5 Com— � -0f�rm OO -0 <br /> (/ �. m <br /> 6. a A <br /> 7. z : !" So i m i <br /> - r . <br /> MI 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 res ° <br /> 9 p g responsible for the detail and accuracy of <br /> all Information contained in this application(Including any accompanying schedule)and I further declare that I recognizen ` i m E ': ? <br /> M <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- p <br /> sue a permit. 1 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 to have access to the abqve dejIlcribed premises at any reasonable time for the purpose of Iof <br /> ns T <br /> SIGN HEREii <br /> ture of building contractor) (date) <br /> g <br /> ZONING ADMINISTRATOR 16 ( i <br /> N NN(A 6f <br /> Cn <br /> iii N N N N N N U <br /> V1 V1 0611 ut OO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />