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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 /> r <br /> OWNER ..P -e � lk,:�( Gi<7i�vEPHONE657�-6to 'J <br /> HOME ADDRESS 3 S52: v-&->✓L'l �/ a <br /> / o <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> t <br /> LEGAL DESCRIPTION (see tax receipt) C p�� . <br /> m <br /> o_ <br /> TYPE OF PERMITS DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE—ADDITION— <br /> SANITARY— <br /> TRUCTURE ADDITION SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° <br /> 0 <br /> N <br /> STRUCTURE/ADDITION USE: V PW <br /> (Home/Ca n; Commercial Business, Bedroom; Deck;etc.) <br /> CP <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> ,n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C) m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS (NB)AND INDICATE m !° <br /> NORTH (N). <br /> C o <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, 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- I <br /> INGS, ROADS, LAKE, LOT LINES. Q <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. h o <br /> 0 g <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE <br /> (`w1I <br /> ISSUED. 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: <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, LU <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN 75 FEET OF THE OHWM OF LAKES, <br /> PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. p ��, p <br /> 8 101 <br /> 6. 0Jer fj LjCD X <br /> � >0' v m c o 3 <br /> 7. o : <br /> N: m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G)- c <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of o <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m m <br /> m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 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 'm <br /> providing in this app' ation. I agree to permit county,officials charged with administering county ordinances or other m <br /> authorized person ha a accesq to the abovescr' d premises at any reasonable time for the purpose of inspection. .n <br /> ., m i <br /> SIGN HERE <br /> (sibnaturk bf owner or bu dingc tr ctor) (date) <br /> ZONING ADMINISTRATOR <n <br /> Encicnc�f»� <br /> N N <br /> Ln N N U t (n <br /> u7 fT 0 M C" OO <br /> OWNSHIP PERMITS MAY B EQUIRED 0 0 0 0 0 0 0 <br /> 0 0 0 0 0 0 0 <br />