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Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator -u o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> w <br /> OWNER TELEPHONE a <br /> �l l <br /> HOME ADDRESS �otd IQ�®fc✓�1 f ,Sf Alf /P o <br /> �/ 0 <br /> EMERGENCY/FIRE NUMBER a y y ROAD NAME GYN✓ <br /> LEGAL DESCRIPTION(see tax receipt) FLY Cva a4l f G✓f a/ h3JAt <br /> 0'tk SnW TdtAx f rn 00-1,01f m <br /> J ox c <br /> � <br /> TYPE OF PERMIT(S):DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE�A DITION C <br /> CL <br /> S. <br /> w <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> N <br /> 7 <br /> STRUCTURE/ADDITION USE: 64 r44 G a 6 x3� OG�a�I�� fir <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) <br /> N <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> 70 a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) <br /> _n <br /> o z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m It <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). (Cii <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER. P <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 5 ° <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 I �' <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 /> O� RI�R UNLESS SPECIFICALLY PERM 'ETA D. <br /> 5. <br /> vs cr.- <br /> 6. <br /> 6. 5 � 3npw pGw <br /> �aQo % <br /> ° wC <br /> 7. Tedz ' u � <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ZS g C <br /> knowledge and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of n a : ` : - <br /> all information contained in this application(Including any accompanying schedule)and I further declare that I recognize m m <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- d 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 m E E <br /> authorized person to have access tjp%akov6 described premises at any reasonable time for the purpose of inspection. -n <br /> CO <br /> w : <br /> 40 <br /> SIGN HERE <br /> ( re owner or building c5tor) /^ (date) <br /> ZONING ADMINISTRATOR <br /> ^ fA WNNN Cn M <br /> N N(7 N N <br /> N NO VI U9 V 1 <br /> O <br /> 0000000 <br /> YO <br /> WNSHIP PERMITS MAY BE REQUIRED 90000000 <br />