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cl�cr3Yy l <br /> Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator -0 o z <br /> APPLICATION FOR LAND USE PERMITS 3 4 <br /> ; o <br /> OWNER ( � OL, TELEPHONE m <br /> Ir <br /> HOME ADDRESS ) I j s G 4 G bye t s5 tL)IS/ <br /> m <br /> EMERGENCY/FIRE NUMBERA n kb J ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) <br /> TYPE OF PERMIT(S):DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION v <br /> °. -� <br /> 5. <br /> rn <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> - <br /> 0) <br /> ` , <br /> ` <br /> STRUCTURE/ADDITION USE: L WK Q, Lil m UV <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) v <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR g <br /> m 3• <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. _ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m Z <br /> 'A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). ,c <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO fn o <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER. 0 <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILD- O <br /> INGS,ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 0Q) <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. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE <br /> ISSUED. g <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. e <br /> CONDITIONS OF PERMIT: Q� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ( w <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. qq <br /> 6. a� m <br /> e= <br /> a l C N a 0 7 ; <br /> 7. O <br /> _ CO m <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of ; o E ° c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize e <br /> M <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m 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 (0 <br /> authorized person to have ac s to the above described premises at any reasonable time for the purpose of inspection. T i <br /> m : <br /> SIGN HERE 1 - <br /> Ill lure of ow or r building contractor) (date) <br /> ZONING ADMINISTRATOR rw <br /> N N01 N 01 <br /> PVt 0010 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 COD 0 <br />