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rj CV7I Lj-- <br /> Burnett County 7410 Co. Rd.K, No. 102,Siren,WI U872 Office of Zoning Admilletratot T 9) c <br /> APPLICATION FOR LAND USE PERMITS <br /> � O <br /> OWNER]L yyl A ,' Tey I TELEPHONE 34� *71 % 2 <br /> HOME ADDRESSC n lR g <br /> _ <br /> I <br /> EMERGENCY/FIRE NUMBER ROAD NAME �(�n { I It <br /> _ l <br /> LEGAL DESCRIPTION(see tax receipt) L-� 3 1 '0 I I C y <br /> TYPE OF PERMIT(S):QWELLINCiIBIiILDING GARAGE/ACCESSORY STRUCTUREII,---4pDITION C <br /> S <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION— <br /> 01 <br /> STRUCTURE/ADDITION USE: <br /> (HonWCabin;Commerdal Business;Bedroom;Deck;etc.) 'a i <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR w <br /> ILLEGIBLE PLOT PIANS WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN D AWIN (AERIAL OR TOP VIEW) p I �' <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. * v' <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m ti <br /> NORTH(N). �Crpp <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO In <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER. <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. <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 /> o <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE � g <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: c W <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT D �� <br /> ISSUANCE. At 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Ci <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICAL4Y <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. <br /> 6. 4M V o r 40 <br /> 0 .0 <br /> a lFg7� <br /> S c !" H E <br /> 7. c n i <br /> I declare that this application (including -y` m <br /> PP ( rep any accompanying schedule) has been exams by me and to the bat ef my ? g p <br /> knowledge and belief It Is true,correct and complete. I acknowledge that I am respond le for the detail and accuracy of C <br /> all Information contained In this application(including any accompanying schedule)and I further declare that I recognize '• s' ; ? <br /> that this information I am providing will be relied upon by the County of Bumslt WIsconsin in determining whether to Is- m <br /> sue a permit. I further accept all liability which may be a result of the County of BumetNreiying on this Information I am <br /> providing in this application. I agree to permit county officials charged with administering county ordinance or <br /> authorized pe on to have access to the above described promises at any reasonable tl rspM <br /> - SE <br /> SIGN HER �► `• <br /> re of Ilding cont vctor) <br /> I Ni i <br /> ZONING ADMINISTRATO <br /> 1 NN N qNq N N~qq <br /> ,`. . "ill N O •fN71�O <br /> TOWNSHIP PERMITS MAY BE REQUIRED __ , .8 8 8 888 <br />