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5)��rw '' <br /> Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator 3 0 0 <br /> APPLICATION FOR LAND USE PERMITS <br /> N <br /> J— �i� ZK1J� a <br /> �i��� TELEPHONE <br /> OWNER O <br /> ` � p J I� ) X2 <br /> HOME ADDRESS ���C{ W 1fV W C S `� &L Pf / <br /> 0 <br /> EMERGENCY/FIRE NUMBER Z 7L�3 ROAD NAME V'jAd6 co <br /> r <br /> LEGAL DESCRIPTION(see tax receipt) Doo � 5 Q E? I ,1.4kLOS <br /> 0 <br /> 1 � � <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE DDITION 5 <br /> N <br /> 7 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION m <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. x <br /> DIRECTIONS FOR PLOT PLAN DRAWING; (AERIAL OR TOP VIEW) n CL <br /> o z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m It <br /> C o <br /> NORTH(N). m la <br /> 3 <br /> 3 CENTERSHOW LINE OF OFOROAD,C)BUILD NG(S)MEASUREMENTNS IN FEET OF THE FOLLOWING: (A) TO THEORDINARY HIGH WATER MARK(OHWM)OF LAKE, c <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. ED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> W I <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANN <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS o <br /> MUST BE SIGNED AND DATED BY THE OWNER. 0. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE C <br /> ISSUED. <br /> Z <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 <br /> ISSUANCE. <br /> CUTTING2. REMOVAL OR VEGETATION RESTRICTED <br /> 3. N GRADING OR HORELAND A TERATIONS AREALLOWEDUNLESS SPEC F CALRY LINE. <br /> PERMITTED. <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN 75 FEET OF THE OH <br /> WM OF LAKE <br /> PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. y <br /> 5. m obi � �m a f tin <br /> 6. 91 m o <br /> 7. m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ` C <br /> CL <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize t7 <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> m <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 E m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. n <br /> h <br /> SIGN HERE (date) E <br /> (signature of o r or building contractor) <br /> 40 40 40 <br /> ZONING ADMINISTRATOR u I;in N <br /> n) 404040 <br /> kc0000(Do <br /> 0NNN � <br /> (T O P P P 0 <br /> 0 0 0 00 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />