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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -oL o <br /> APPLICATION FOR LAND USE PERMITS . <br /> a <br /> c <br /> TELEPHONEOWNER,kjL0 W <br /> a v r�N a r9 t 5- qK Q <br /> HOME ADDRESS glopoo6l 5 <br /> r o <br /> 0 <br /> EMERGENCY/FIRE NUMBER 0 + ROAD NAME <br /> L <br /> r <br /> LEGAL DESCRIPTION(see tax receipt) Co <br /> '1 <br /> y � <br /> TYPE OF PERMIT(S):DWELLINGBUILDING GARAGE/ACCESSORY STRUCTURE ADDITION n <br /> 5: C <br /> a <br /> SANITARY PRIVY FILLING/GRAD I CAMPING UNIT SUBDI,VISIQf� Cir /.��j. y 0 <br /> V/Q,lu f 11` J <br /> STRUCTURE/ADDITION USE: _ R Iace_C)NS h UO 6 S <br /> (Home/Cabin; Cdrnmercial Business; Bedroom;Deck;etc.) 00 o <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> M 0 C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 1 'a <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C it O <br /> NORTH(N). to <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m a <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- (7y <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 e <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 3 S. OD <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o 1 <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <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. <br /> mit- R CZZ% D <br /> � < :0 'V <br /> 'v vOr'oQpQg,o mNQ <br /> M 3F Q <br /> 7. o : <br /> —Ni i ° IG <br /> [ m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <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 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- <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 f m E E <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. r ': <br /> SIGN HERE — ��' 1/�AG�'�..• <br /> ( na re of r r ilding contractor) date)._. <br /> ZONING ADMINISTRATOR <br /> MHHHM� <br /> N a N N n O <br /> p10N Ns]O <br /> O O O O O O C <br /> TOWNSHIP PERMITS MAY BE REQUI <br />