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` o '`'p <br /> Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator a o c <br /> APPLICATION FOR LAND USE PERMITS . <br /> w <br /> OWNER �G1\ (J�22�Q\(A IV TELEPHONE <br /> HOME ADDRESS 7 s {�Q J �j K ��Q`p QY 1� 5 t_ <br /> EMERGENCY/FIRE NUMBER � � / ROAD NAME �^ <br /> LEGAL DESCRIPTION(see tax receipt) 5 �,/ D� 5 D F �� O M �' 4G I y <br /> cc <br /> TYPE OF PERMIT(S):DWELLING/BUILDING GARAGE CCESSORY STRUCTURE ADDITION- <br /> g: (� <br /> S' . <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 t �. <br /> STRUCTURE/ADDITION USE:��\� y r QG Q �V 1\\ N 4 sr <br /> om Cabin;Comm rcial Business;Bedroom;Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR _n w <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. ca <br /> 711 c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0n <br /> In O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 00 �0 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C 0 <br /> NORTH(N). (A �° <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m „, <br /> v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, X0 Z <br /> 0 <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. <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. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE U ° <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o U <br /> CONDITIONS OF PERMIT: �J <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT �j <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. O O V <br /> moHis ”' <br /> 6. waw �mIC <br /> 7. <br /> o : <br /> _cn m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ie g E E 'CO <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of n I? <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize �^ m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Is y D <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 <br /> authorized person to have aclipitss to the above described premises at any reasonable time for the purpose of inspection. <br /> m <br /> _�►� `�7 <br /> SIGN HERE <br /> ( gnat re of owner r wilding conVactor) (data) <br /> ZONING ADMINISTRATOR w ee 40 H w N <br /> a �oc�'i��oo <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 0 0 0 0 0 <br /> 000 000 <br />