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Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator c 0 <br /> APPLICATION FOR LAND USE PERMITS y� <br /> 0 <br /> � - 14131 <br /> m <br /> OWNER TELEPHONE ^p <br /> Q� � � Is, O <br /> HOME ADDRESS U�J�I �a - L�yfi.()' b•, l Ua K /L!- `✓ `v <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> �d11C� <br /> LEGAL DESCRIPTION(see tax receipt) in <br /> i� <br /> e <br /> TYPE OF PERMIT(S):DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION a <br /> 5. <br /> SANITARY PRIVY FILLING/GRADING CAMPIN/G/ UNIT SUBDIVISION-1)(7— <br /> STRUCTURE/ADDITION USE: v z <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) - C <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR T » 9 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) c <br /> r o n z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 0 '0 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE a .. c <br /> NORTH(N). W <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, z <br /> 0 <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. 1 <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 o <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 C ° <br /> ISSUED. 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z J <br /> CONDITIONS OF PERMIT: o C <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT t <br /> ISSUANCE. <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. I <br /> £ <br /> 5. 3 3E R. � <br /> a <br /> 6. v : 9CItoo �� <br /> o <br /> 7. =rn: i <br /> A <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Gf c E C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of ii` M <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize w B : m <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. 1 further accept all liability which may be a result of the County of Burnett relying on this Information I am m i <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 /> m : <br /> SIGN HERE (date) <br /> (sig—nat�ureeof owner or building contractor) <br /> ZONING ADMINISTRATOR 1 1(Y� r 1(�S�Ifir��l • H M H H N N L` <br /> �J � Po ��oo <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> 0000000 <br />