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Burnett County 7410 Co. Rd. K, No. 102, Siren,W154872 Office of Zoning Administrator -0 o° o <br /> • APPLICATION FOR LAND USE PERMITS 3. <br /> I- <br /> N O <br /> N41 <br /> CD <br /> M C <br /> OWNER <br /> Ii � 2 � rd�c <br /> 1 ( TELEPHONE p <br /> CD 0 <br /> HOME ADDRESS I Sb — —1—� J `� v o CD <br /> EMERGENCY/FIRE NUMBER ROAD NAME �+ f�3SS K• tom, <br /> LEGAL DESCRIPTION (see tax receipt) �,nQ LUT- a, . �1— <br /> !n O <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION c <br /> <. (� <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION \'Y) <br /> d <br /> STRUCTURE/ADDITION USE: Csm V. IZo <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) m <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. ; N <br /> c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n a <br /> -nO Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m mC a <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 AND MEASUREMENT TO WETLAND AREAS. <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. t <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. o <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. o <br /> v w <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ( l <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. _- m w e0 o m <br /> 6. <br /> mca" " 0 � 3 <br /> m <br /> 7. = Cn m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my — 0 C <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of W <br /> CL m X!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 Bumeft 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 m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> CD <br /> SIGN HERE (date) <br /> (signature of owner or building <br /> contractor) <br /> ZONING ADMINISTRATOR m <br /> N N Oi N N Vt Ut <br /> O V O O O O <br /> 0000000 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 o 0 o 0 <br />