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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator �0 G) Z <br /> APPLICATION FOR LAND USE PERMITS 3 ° <br /> a <br /> PIP0 � <br /> OWNER* if�M LW TELEPHONE & <br /> 7l S'' S3q o3 b 9 0 <br /> d <br /> HOME ADDRESS w' S`1�U 3 O <br /> V AY•Y' <br /> CD <br /> CD <br /> p fSI <br /> EMERGENCY/FIRE NUMBER ROAD NAME N 6 <br /> , � Wk_ 0 <br /> LEGAL DESCRIPTION(see tax receipt) Sg , <br /> r <br /> Y r � <br /> TYPE OF PERMIT(S): DWELLING/BUILDING �` GARAGE/ACCESSORY STRUCTURE______ADDITION_ <br /> ADDITION n <br /> c <br /> c <br /> a <br /> w' _- <br /> SANITARY PRIVY FILLING//GRADING CAMPING UNIT SUBDIVISION <br /> Cn <br /> STRUCTURE/ADDITION USE: � *� ( � •n• <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) -I <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. �t <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING7 (AERIAL OR TOP VIEW) G c <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. o Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m 6 <br /> NORTH(N). <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, 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- Q <br /> INGS,ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <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. 1 ` <br /> oi W <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN0 _ <br /> ISSUED. BE Cr ° <br /> 1 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z Q <br /> CONDITIONS OF PERMIT: P (1 I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> 1 <br /> ISSUANCE. c) <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 <br /> RIIVERUNLESSS SPECIFICALLY PERMITTED <br /> W'G /A-X 44PP <br /> 7Z GF_ FiIP!/J <br /> I v6. q W4jn p . <br /> NE <br /> 7. 73 // p n // o :gt m — <br /> I declare that this applica on (including any accompanying schedule) has been examined by me and to the best of my A <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy ofm 0 `• C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize ' CL <br /> m `• M <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> providing <br /> s- L7 p <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 /> rovidin pp g d <br /> p gin this application. I a r ermit county officials charged with administering county ordinances or other <br /> authorized perso o have access the bo described premises at any reasonable time for the purpose of inspection. <br /> m <br /> e : <br /> SIGN HERE A, a _� <br /> Cigna a owner orb ildi contractor) (date) <br /> ZONING ADMINIST T R <br /> www40 <br /> N NN NN Ili <br /> N U1 O (JI N O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 <br />