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OfLCD <br /> Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator a 0 0 Z#7 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> •� r <br /> . No <br /> OWNER <br /> , TELEPHONE <br /> m <br /> ,�t 7 �D L $ <br /> HOME ADDRESS � � / �• `7 v, oCly Z �`i y <br /> o <br /> EMERGENCY/FIRE NUMBER l � Z ROAD NAME u Z 1 <br /> LEGAL DESCRIPTION(see tax receipt) <br /> -/ ,3, =r3 2� y <br /> t �Jo I�n <br /> N <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION v <br /> CL (} <br /> 120. <br /> kj <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> p <br /> STRUCTURE/ADDITION USE: u_ �_ — it •�.g e E <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. In UJ <br /> 0 w <br /> DIRECTIONS FOR PLOT PLAN DRAWING• (AERIAL OR TOP VIEW) 0 C <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 0; A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m ,9n <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. m c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 5 g <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: O <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. r,1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. CN <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY y <br /> PERMITTED. 0 <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 /> 6. 3 1 o <br /> w _ <br /> 7. ZE �^ eq : �m1 <br /> o <br /> ca Mm <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c i p <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all Information contained in this application(including any accompanying schedule)and 1 further declare that I recognize �o m <br /> that this information I am providing will be relied upon by the County of Bumett Wisconsin in determining whether to is- t7 <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this Information 1 am <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other 3 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> o : <br /> ` o <br /> SIGN HERE L J k_�y IY77 `p ' <br /> (signature of owner or building contractor) (date) i <br /> ZONING AD ISTRATOR J i/11 1 ��I GIo�{l I` ' '• <br /> 40hwwww� <br /> N N fn""En o, <br /> U1 Unp Nnp OO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> 0000000 <br />