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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872Office of Zoning Administrator � �0 zp <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> y a <br /> w <br /> OWNER y�^Q ? TELEPHONE�Tts, g��^�7S a <br /> HOME ADDRESS 63 Z S. O <br /> 4e L= wvri It toelG z 0 <br /> EMERGENCY/FIRE NUMBER g=. 7,a707p2 ROAD NAME '�orr_ 2� o <br /> LEGAL DESCRIPTION(see tax receipt) VO f, ?_04 -%>03 t�� f �� 2l�{ i- t <br /> 2 - 1 m <br /> n <br /> TYPE OF PERMIT(S):DWELLING/BUILDINGSTRUCTURE--%4--ADDITION- <br /> SANITARY- <br /> tiQa5. <br /> 0 <br /> DDITIDN <br /> SANITARY <br /> PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> ca <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m ^, <br /> DIRECTIONS FOR PLOT PLAN DRAWING- (AERIAL OR TOP VIEW) 0 w <br /> O m <br /> m a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T o Z m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE ar <br /> NORTH(N). C n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO MFA <br /> 3 <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, <br /> STREAM OR RIVER. Z <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. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE9 <br /> ISSUED. Cr <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. h <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 ST9MCTtiRES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN 75 FEET OF THE OHWM OF LAKES, <br /> PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. // <br /> 6. .`�l�7 L,[C'/1 )'� m d �m L m <br /> M7. <br /> Z : <br /> _Cl): . <br /> I declare that this application (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 of <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize �m ; m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 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 /> providing m <br /> p gin this application. I agree to permit county officials charged with administering county ordinances or other � <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> r� <br /> SIGN HERE <br /> signs re of owne or ilding contractor) (date) �I i <br /> ZONING ADMINISTRATO <br /> TOWNSHIP PERMITS MAY BE REQUIRE 0 0 0 0 0 0 0 <br />