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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator v o 0 <br /> APPLICATION FOR LAND USE PERMITS 4 <br /> r <br /> w' o <br /> OWNER G A R Y N SC M o c K TELEPHONE -7 IS R 7S7n G <br /> m <br /> HOME ADDRESS � /� � �/ PC 14 � �` 4 M E R U y0o/ O <br /> o <br /> EMERGENCY/FIRE NUMBER A / ROAD NAME <br /> LEGAL DESCRIPTION <br /> ( receipt) <br /> see tax recei <br /> TYPE OF PERMIT(S):DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE—(L—ADDITION/ C 0 <br /> 3 <br /> C <br /> v <br /> a <br /> 5. <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Com ercial Business;Bedroom;Deck;etc.) 1 <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR R <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. It 3 <br /> DIRECTIONS FOR PLOT PLAN DRAWING- (AERIAL OR TOP VIEW) C <br /> -n ig <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. M v Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m S <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 v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, <br /> STREAM OR RIVER. Z <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. I <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS i <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 <br /> GJ <br /> ISSUED. 5 ° <br /> n <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z _. <br /> CONDITION OF P RMIT: P <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. I <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. pp <br /> 6 � <br /> . � 3 ajE� om <br /> g� <br /> _U)i ' 70 <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of myi ' m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m ` C <br /> all information contained in this application(Including any accompanying schedule)and I further declare that I recognize W m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 63 i 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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> �Q ` oo : <br /> SIGN HERE <br /> " 7 142 l -7 �^ <br /> (signature of owner r building contractor) (date) <br /> ZONING ADMINISTRATOR 1 <br /> rj Hun N)r4 NH <br /> N Nn p N N pp <br /> ut NONN OO <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />