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Burnett C�,junty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator a G) Z <br /> APPLICATION FOR LAND USE PERMITS . <br /> 0 d <br /> OWNER— ' J TELEPHONE �� _ ���� a <br /> HOME ADDRESS 7 � I y W ekIr. [,� <br /> (((LLLL 4eo 0 <br /> EMERGENCY/FIRE NUMBER 7 ROAD NAME 5 ✓ .. <br /> LEGAL D SCRIPTION(see tax receipt) �.( _ / / �j—/a�'� T <br /> TYPE OF PERMIT(S):DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION cr <br /> w <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0)� V I <br /> STRUCTURE/ADDITION USE: <br /> -F <br /> (Home/Cabin;Commercial Business;Bedr m;Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. Ci <br /> Up <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 <br /> M ^ Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 'q <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). y v c <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. 9 <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 S f <br /> MUST BE SIGNED AND DATED BY THE OWNER. ,a o <br /> v � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE <br /> ISSUED. kAo <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o ` I <br /> CONDITIONS OF PERMIT: C <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. O <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY d <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 /> 3 n 3F¢ <br /> 6. v v Cw a c <br /> 7. c : a �� : '`° <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of ma L' S <br /> i R i .� <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize O; : e '• '• <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- d ; : v <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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other E <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. E <br /> SIGN HERE t/Z <br /> gn4reo er or buildin contractor) (date) <br /> ZONING ADMINISTRATOR w <br /> w(n <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0,3 0 0 <br /> 1 0 0 <br />