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Burnett County 7410 Co. Rd.K, No.102, Siren,WI 54872 Office of Zoning Administrator $ ° o <br /> APPLICATION FOR LAND USE PERMITS <br /> r a » <br /> OWNER /3 J)') 1 ! �Sa/ '� TELEPHONE/—)/ b ST o <br /> B <br /> HOME ADDRESS Q , Cf S�7'f� /\ 1 �' I/C � J `�Ir- <br /> 0 <br /> ROAD NAME( <br /> EMERGENCY/FIRE NUMBER 5i4/'YIP S y <br /> 1 \ — <br /> ( p <br /> LEGAL DESCRIPTION see tax receipt) a <br /> N 0 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION Cr <br /> 5. ^` <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION m 0 <br /> STRUCTURE/ADDITION USE: <br /> bec � <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) M <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR O <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. ,rt► w <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) -n Z <br /> O <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m mS <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE y .. c <br /> NORTH(N). <br /> 3 CEN ERSHOW LINE OF ROAD, C)BUENSINS IN FEETOILD NG(S)MEASUREMEF THE FOLLOWING: (A)NTUTO THE( <br /> (ORDINARY H GH WATERBILDINGS)TO ALL LOT LINES, (B)BUILDING(S) <br /> OH(WM OF LAKE, m c <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 c <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE g <br /> ISSUED. <br /> Z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT J" <br /> ISSUANCE. <br /> 1111 <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. M 'o3EEMU. <br /> L <br /> 0 3 <br /> 6. 91 m o :m — <br /> Z : <br /> i w *1'z : i .'0 <br /> _y E m <br /> 7 <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Gf i c <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of ' Er ; ? ? ;0 <br /> all information contained In this application(including any accompanying schedule)and I further declare that I recognize m <br /> L�i O <br /> that this information I am providing will be relied upon by the County of Burnett 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 Burnett relying on this information 1 am <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other E W <br /> authorized person =gnature <br /> scribed premises at any reasonable time for the purpose of Inspection. <br /> m : <br /> SIGN HERE (date) <br /> building contractor) <br /> H <br /> ZONING ADMINISTRATOR \J"7) • N H N N'A N <br /> N N� NN V•N <br /> fn f71 O f)1 U1 O O <br /> O 0 0 0 0 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />