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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator � <br /> APPLICATION FOR LAND USE PERMITS <br /> y O <br /> m ^ � <br /> / c �J <br /> OWNER 1��ua�as I �t I 9 TELEPHONE a <br /> HOME ADDRESS <br /> '20 <br /> 60 I!2D C7c1L1X(X� 3a ok� yI V s� m� <br /> 0 <br /> EMERGENCY/FERE NUMBER ROAD NAME K I <br /> LEGAL DESCRIPTION(see tax receipt) X <br /> Ca <br /> O <br /> Co 0 <br /> TYPE OF PERMIT(S):DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION C <br /> c <br /> v KJ) <br /> CL <br /> S. <br /> SANITARY PRIVY FILLING/GRA\DINNG CAMPING UNIT SUBDIVISIONA— E. <br /> CA <br /> �Sm V � �� Ur1 <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) 1 <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR 9t <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. In 3. <br /> O <br /> DIRECTIONS FQR of OT PLAN DRAWING. <br /> (AERIAL OR TOP VIEW) O o <br /> nn <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m If <br /> NORTH(N). C C7 <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, <br /> STREAM OR RIVER. Z <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 0 <br /> ISSUED. g — fSli <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z T v , <br /> CONDITIONS OF PERMIT: o nO,, <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT l c <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 }U� <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN 75 FEET OF THE OH <br /> WM OF LAKES, <br /> PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. <br /> s. 3 nt1 m <br /> a <br /> a O C N w O E ; <br /> 7. c : H o i 0m i <br /> Cn <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of 3 m C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize mm m <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin i t determining whether to recognize <br /> is- 63 p <br /> sue a permit. I further accept all liability which may be a result of the County tt Burnett relying to this information I am m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> - <br /> SIGN HERE mw '• <br /> (signature of owner or building contractor) (date) <br /> ZONING ADMINISTRATORFilmj . . . i <br /> fR M <br /> tq CR <br /> racn" + <br /> N Nb1N PN <br /> N V1 ON NOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />