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Burnett County 7410 Co. Rd.K, No. 102,Siren,W154872Office of Zoning Administrator 0, o <br /> APPLICATION FOR LAND USE PERMITS 4 <br /> r <br /> u o bD <br /> 1/�/ 1 I <br /> OWNER 111II1� � �r be1 Sta!'I Io1TELEPHONE�- <br /> HOME ADDRESS "F'l�"� • I�d -� n jP Sl P <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) <br /> AJ <br /> I1 ) IVU) 2L _' -5— l^' I t <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION— J- <br /> a <br /> S <br /> SANITARY PRIW FILLING/GRADING CAMP ING UNIT SUBDIVISION—,X,— <br /> STRUCTUREDDITION USE: B <br /> /A _ <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) 1 <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. �r <br /> DIRECTIONS FOR PLOT PLAN DRAWING- (AERIAL OR TOP VIEW) p � <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. _ <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m 6 <br /> NORTH(N). C O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO M3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER. o <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. 1 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. e <br /> o9 SO <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ?, SO <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> i <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. <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 /> ;1] 'V0rG O 'e <br /> 7. <br /> -rn: m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application(Including any accompanying schedule)and 1 further declare that I recognize 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 ? 'm <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m E <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection m <br /> m i <br /> SIGN HERE <br /> (signature of o <br /> wner or building contractor) (date) <br /> ZONING ADMINISTRATOR <br /> N NNNNN N+ <br /> N NO,iNT NOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 0 0 0 0 o <br />