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X C/J-/L� <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -V o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> N 0 <br /> m <br /> c <br /> OWNERrl�a� TELEPHONE <br /> HOME ADDRESS �l 35 � y /� f sc�G3v <br /> m <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) CJ yy, JlJlJYy 5?&q -FilCn <br /> m <br /> 00 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTUREADDITION � <br /> Cr <br /> CL <br /> V\ <br /> N <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT-SUBDIVISION 0 <br /> STRUCTURE/ADDITION USE: C�iH ty— <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 n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 _ <br /> .�I N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 c <br /> O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS (EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). Co <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 /> STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. P <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. o <br /> g � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE q <br /> ISSUED. i <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: n ' <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT W Q ry <br /> ISSUANCE. l "`JJJQ <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 /> A 0r�0 � 0 <br /> <. N CD <br /> 6. < N C N w O �+ <br /> 7. o N COD <br /> [ o,: m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m c p <br /> Pp (� 9 Y ) Y Y <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of n <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- y 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 am Lu: m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other CD <br /> o <br /> authorized person to have access to the abo e ciscribed premises at any reasonable time for the purpose of inspection. T <br /> - : <br /> pp m : <br /> SIGN HERE -- 9 7 C,) <br /> (sign atu o ownerorbuildi ntractor) (date) <br /> ZONING ADMINISTRATOR <br /> N N Ut N <br /> u N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 0 0 <br />