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Administrator Admq °Z <br /> Burnett County 7410 Co. Rd.K,No.102,Siren,WI 54872 Office of Zoning 3 4 <br /> APPLICATION FOR LAND USE PERMITS w <br /> a <br /> c <br /> OWNER /�( TELEPHONE 7/S ' 7�y�� <br /> Z /4 .. O <br /> HOME ADDRESS A LI 12 9-0 h!!c. l/ "aw <br /> ROAD NAME SLfNj C <br /> EMERGENCY/FIRE NUMBER <br /> � r <br /> ur <br /> �a c <br /> LEGAL DESCRIPTION(see tax receipt) / ` c <br /> m � <br /> TYPE OF PERMIT(S):DWELLING/BUILDING RAGE/ACCESSORY STRUCTURE DDITION rr <br /> N <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ur <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Busines ;Bedroom;Deck;etc.) �- <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR O 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 CD <br /> c <br /> cL <br /> DIREGTIOhS FOR PLOT PLAN nRgWING (AERIAL OR TOP VIEW) -n 'ZA <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN 70 SCALE. m g <br /> C <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICA 0 <br /> N 3 <br /> NORTH(N). m <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <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, <br /> UIL -INGS,ROADS,LAKE, LOT LINES. 64 <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 2 <br /> o <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLAN O <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> Cr <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE <br /> ISSUED. Z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: l <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT q <br /> ISSUANCE. I�NJ( <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. p = dpR o m <br /> 5. 0) <br /> 3n2nQ .O <br /> v � yoy �� 3 <br /> 6. o GQ <br /> _w: : m <br /> 7. <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my C <br /> m m i rr <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of ii� � m <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize C <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> y <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 ': <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have to the above descri premises at any reasonable time for the purpose of inspection. m <br /> H : <br /> l <br /> SIGN HERE (date) <br /> (signature of er or build g con <br /> H fA VI to iR <br /> ZONING ADMINISTRATOR N N p,o 0 N N a rr <br /> � P,p,o 0 <br /> 0000000 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />