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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -gt 0 0 <br /> APPLICATION FOR LAND USE PERMITSFA <br /> 3 <br /> w <br /> OWNER f ,� G��� TELEPHONE <br /> 7 y <br /> HOME ADDRESS (7 oC O'6ULAN 0 <br /> EMERGENCY/FIRE NUMBER Q 3 ROAD NAME <br /> 1 r� <br /> LEGAL DESCRIPTION(see tax receipt) C-6 10 ✓ )1=,NC A.OS CFV y <br /> g <br /> e <br /> CO g <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION_X_ Q <br /> S. <br /> S. <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> ra <br /> STRUCTURE/ADDITION USE: 6i <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 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. pm <br /> A C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m iZp <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> NORTH(N). y G <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m a <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, 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. `2 <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 v l <br /> MUST BE SIGNED AND DATED BY THE OWNER. m o <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE q <br /> ISSUED. T <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P Y` <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. (fl <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. <br /> No 1 n 50e., Uvak-� PreSS WC 6Y5tVr—' ;a -V 0 r.- G o <br /> 6. �(n U�Lt be. iol-6-t,, Io-E. 1 `,,,e_. 9 = ;a I MM <br /> gt <br /> 7. f no+_-� eVeeLj Cc4f r+ert , �a if" /ria�� V_I k6e, z : !^ 8� : :'? =1 <br /> P <br /> y E i 7J <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my ii ' ID <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize o : E : m <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to the above described premises at any reasonable time for the u rCD <br /> E E <br /> SIGN HERE <br /> (signature ofjprwner or building contractor) / I (dat <br /> ZONING ADMINISTRATOR �. WSW i" ' w <br /> HHHHW40 <br /> 10 <br /> 1 t,N7i VtOfNTNOO <br /> TOWNSHIP PERMITS MAY BE REQUIRE 0 0 0 0 0 0 0 <br /> 0000000 <br />