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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> � )n l n <br /> OWNER /V fi THA AJ �i�UCs TELEPHONE I J 3 0 Z a <br /> v� <br /> HOME ADDRESS e o I L 3 S P�f� OE-k <br /> Ar, 501 � <br /> n r m <br /> EMERGENCY/FIRE NUMBER O� ROAD NAMEChi Rnn d 6- <br /> LEGAL DESCRIPTION(see tax receipt) a S►) v, <br /> y <br /> 8 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION C ' <br /> c <br /> n <br /> 5. <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> STRUCTURE/ADDITION US <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) -I <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T 3 <br /> DIRECTIONS FOR P QT PLANDRAWING- (AERIAL OR TOP VIEW) 0 <br /> m a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m s Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m $ <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO M �3 <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- o <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 6 <br /> MUST BE SIGNED AND DATED BY THE OWNER. c / , <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATIONBEFORE A PERMIT CAN BE V �+ <br /> ISSUED. 5 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z w <br /> CONDITIONS OF p RMIT: o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. J <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 /> 5. PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> m mm ��t7 � <br /> 6. 2 3 'a 4 %x m <br /> 7. <br /> 9 eCinNoS � <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my yr D <br /> 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 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- <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 3 <br /> CD <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. <br /> In : <br /> m <br /> SIGN HERE <br /> n <br /> (sl atu of own r build g contractor) ---(dkte) <br /> ZONING ADMINISTRATOR <br /> 44,w <br /> N N VtNNN Vt <br /> I Vt (71 O V1 Vl O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED U L ._ ? 0 0 0 0 0 0 0 <br /> 0000000 <br />