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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator T 'G) <br /> APPLICATION FOR LAND USE PERMITS . <br /> r <br /> c <br /> OWNERR(c_ r t!-:,4 n e 12 TELEPHONE <br /> HOME ADDRESS 0(O %'t. _1 E G� a,+ R t ,L 2 Les ke Ke �Z <br /> o <br /> EMERGENCY/FIRE NUMBER �10� 4 3 ROAD NAME jC , �(�� <br /> 00 <br /> LEGAL DESCRIPTION(see tax receipt) 5 1 Q2S I R 14 LQ <br /> Co <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAG ACCESSORY STRUCTURE�6�ADDITIONY c <br /> a <br /> V <br /> S. <br /> E <br /> SANITARY PRIVY FILLING/GRADING 'CAMPING UNIT_ SUBDIVISION o <br /> STRUCTURE/ADDITION USE: QT�P 'IE EJ <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) i <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR m <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. ^' <br /> x N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m g <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). y c <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 0 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER. P <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. `2 <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 o <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 3 <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> 0 <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. l <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 /> 6 Pcc61 1O r f• O� c3i� P��� m m 202 o v <br /> 7. c : <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my g p <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of d 1, '• C <br /> CL <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize o Mm <br /> that this Information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- y t7 <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 d E <br /> providing in this application. I agree to permit county officials charged with administ m <br /> authorized person to have access to the above described premises at any reasonable 0 rt; u5pplt a of 1r 40 -n <br /> SIGN HERE <br /> (signature of owner or building contractor) ,(signature of owner or building contractor) (�1 <br /> r <br /> ZONING ADMINISTRATOR f laRl �� <br /> MNiRN 40(n <br /> N NN N NNfn <br /> Vt N OVI(IIOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />