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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator U c) Z <br /> r APPLICATION FOR LAND USE PERMITS . <br /> OWNER TELEPHO <br /> HOME ADDRESS 719W437//e 9 <br /> ,. , 1 <br /> / <br /> EMERGENCY/FIRE NUMBER Zg2Sy ROAD NAME <br /> 9-)1 <br /> /n '//�i✓O Fr �X/iT�1l <br /> q r <br /> LEGAL DESCRIPTION(see tax receipt) S m <br /> X 0 <br /> N <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION K_ <br /> Cr <br /> S <br /> 5. DN, <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> / ) Cn <br /> 0 <br /> STRUCTURE/ADDITION USE: G/ ✓ N G d a '-6i (� <br /> (Home/Ca in;Commercial Business; Bedroom;Deck;etc.) <br /> v _ <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> m <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. yluM 0�. _ m <br /> DIRECTIONS FOR PLOT PLAN DRAWIN PC �"6��I <br /> (AERIAL OR TOP VIEW) 0 <br /> 61v Plat T_IC " a <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE, m 0 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). r <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 Z <br /> STREAM OR RIVER. c <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. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. to <br /> c <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 5 0 <br /> ISSUED. <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. R e6o,_, WA-11 Ai— U-3f - 1be- rcmoU4 yr (6%- cow WA n �o� _k ARVo�°� � � 0 r-Rp o CD Lo � <br /> 6. A,l( C{�t4+UwbC4 V` rote 4 " CWg4,:.� U h T-ap So,I t- 5,0e f rL'ff Y 9, o C <br /> z M <br /> 7. M , . . <br /> o <br /> U) : <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 ofm C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize o 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 liability which may be a result of the County of Burnett relying on this information I am d <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other (a <br /> authorized person to have access to the above Oescribed premises at any reasonable time for the purpose of inspection. T <br /> SIGN HERE ) ;� w E E E <br /> - 1 <br /> g re of ow r r buildingcontractor date) I <br /> ZONING ADMINISTRATOR <br /> �H4h4ftW� <br /> N N(11NN U1N <br /> it I v, v,Ov,u, OO <br /> TOWNSHIP PERMITS MAY BE REQUIRED �' " "- -� - 0 0 0 0 0 0 0 <br />