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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS a. 4 <br /> N o <br /> N � <br /> OWNER ZrIG TELEPHONE ��Cf3 0 V <br /> HOME ADDRESS �z ) 0 <br /> EMERGENCY/FIRE NUMBER 3 ROAD NAME I <br /> t <br /> LEGAL DESCRIPTION(see tax receipt),:�f� 013 �G+�y �0 1f? � , E8+3.6Y O/=�1 � �/.>'Y Y� � m <br /> CrdU, LOT c <br /> y <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTUREy ADDITION <br /> Cr <br /> CL <br /> 5. <br /> La. ` <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION )�f <br /> „1 <br /> y �J <br /> STRUCTURE/ADDITION USE: A <br /> Home/Cabin;Commercial Bu ess; Bedroom; Deck;etc.) <br /> v r\ <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> O <br /> A c <br /> DIRECTIONS FOR PLOT PLAN DRAWING• (AERIAL OR TOP VIEW) O <br /> M 0 Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <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. o <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. 643) <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 0 <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. c <br /> v 0 UJNOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE <br /> ISSUED. �, XJ <br /> ISSUED. g <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z .. <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ( i <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. f/� a(y4-5qj I CK 120 <br /> a m <br /> r- 0'. <br /> o <br /> y : € m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my C p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofCL <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- y o <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 :ave access to the above described pre ises at any reasonable time for the purpose of Inspection. -n <br /> m : <br /> ` m : <br /> SIGN HERE <br /> g <br /> nature <br /> hoff owner <br /> �- <br /> or�building coon Tactor) (date) <br /> ZONING ADMINISTRATOR ; JjT(n flh/Ljaf1 E <br /> w ww,n,nEn CA <br /> N(TNNN(T <br /> N ,r 1 O N U I O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />