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�/� C� <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 64872 Office of Zoning Administra'for I $ o <br /> APPLICATION FOR LAND USE PERMITS 3 �A� <br /> R <br /> c ` l1 <br /> OWNERTELEPHONE <br /> ec� n <br /> o1K-J3t,{r ne �l -I'C' o <br /> m <br /> O <br /> HOME ADDRESS <br /> W » � <br /> EMERGENCY/FIRE NUMBER ROAD NAME OI Q <br /> LEGAL DESCRIPTION(see tax receipt) I <br /> 0 <br /> y � � <br /> TYPE OF PERMIT(S):DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION `or <br /> Q: <br /> SANITARY PRIVY F11 LING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> W <br /> STRUCTURE/ADDITION USE: lir <br /> lel - i5� <br /> (Home/Cabin;Commercial Business; Bedroom;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. <br /> C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 <br /> FL <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. S jp <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE M <br /> NORTH(N). y 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m o <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER. 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. pp <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 VJ <br /> MUST BE SIGNED AND DATED BY THE OWNER. m' c <br /> v � � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE Kr S <br /> ISSUED. a y <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT r�r <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 /> x -0 0 r,- 0k013 <br /> rn <br /> 6. v.� � �o00= N <br /> 7. o N GO ? � <br /> i : : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my GZ5 c p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofc` E S <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- ni m 0 <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 E <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. m <br /> : <br /> m : <br /> SIGN HERE <br /> (signatureofowner r building contractor) (date) <br /> ZONING ADMINISTRATOR 1 1111 ` ` ` ` . <br /> . h <br /> wwwwwd <br /> N NUS NN (nCAN <br /> N O V1 NO O <br /> 0 0 0 0 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> 0000000 <br />