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Once, <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 'it o 0 <br /> APPLICATION FOR LAND USE PERMITS s. 4 <br /> w o ry <br /> C <br /> OWNER TELEPHONE ,��' <br /> 7 ! <br /> HOME ADDRESS /f/3 �0 Q 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME 4-1 <br /> I <br /> LEGAL DESCRIPTION(see tax receipt) / / W <br /> t <br /> TYPE OF PERMIT(S): DWELLING/BUILDINGy GARAGE/ACCESSORY STRUCTURE ADDITION Q <br /> CL <br /> SANITARY PRIVY FILLING GRADING CAMPING UNIT SUBDIVISIONc <br /> Cn <br /> m <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Co mercial Busi ss; Bedroom; Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR V� <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m <br /> DIRECTIONS FOR PLOT PLAN DRAWING- (AERIAL OR TOP VIEW) T <br /> n o z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m i3 <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 M a3 <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, I <br /> STREAM OR RIVER. Zo <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. y <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 c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE5 0 C-7 <br /> ISSUED. o. <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. �1 <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. 2 e� <br /> 6. bio a3F ;M0 <br /> 91 00 =,a <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 ; 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 i ro 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 l23 <br /> iabili ich may be a result of the County of Burnett relying on this Information 1 am d <br /> providing in this appiicati I a ree ermit county of vials charged with administering county ordinances or other o <br /> authorized person to h acces to th bove described premises at any reasonable time for the purpose of inspection. <br /> � <br /> j m : <br /> SIGN HERE �," / ; `A <br /> �+Ign#ure of ow r building contractor) (date) i <br /> ZONING ADMI ISTRATO ?,1 ' AN 1 5 199T <br /> w <br /> 1 N N N N N 01 N <br /> P p1 0 to(71 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRE I x 0 0 0 0 0 0 <br />