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Burnett County 7410 Co. Rd. K, No. 102, Siren,W154872 Office of Zoning Administrator v ci z <br /> APPLICATION FOR LAND USE PERMITS 3 4 °_ <br /> .. 0 <br /> � y O <br /> OWNER J o�{� V lie I S TELEPHONE T o <br /> o <br /> d <br /> HOME ADDRESS <br /> o g <br /> EMERGENCY/FIRE NUMBER ROAD NAME �) � ) 0�)0(_' <br /> LEGAL DESCRIPTION(see tax receipt) V 1 / r <br /> ca <br /> TYPE OF PERMIT(S):DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION C <br /> c <br /> c <br /> n <br /> w' <br /> SANITARY PRIVY FILLING/GRrADIDING1/ CAMPfIIN�GUNIT I�p SUBDIVISION <br /> ca <br /> STRUCTURE/ADDITION USE: (2s1 I 1 V e �� "f' (O �j I� la. <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) 3 <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. In r. F <br /> DIRECTIONS FOR PLOT PLAN DRAWING- (AERIAL OR TOP VIEW) � � <br /> 'nj z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 0� � ;b <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m <br /> CENTERLINE OF ROAD,(C)BUILDINGa <br /> 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- 1)jINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. n I <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. o _ <br /> o w <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ,q 0 6 <br /> ISSUED. Yeo <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. oz <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT I 8 <br /> ISSUANCE. o �, <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. qQ <br /> A 3 k o m <br /> 6. <br /> � v Cwwwc • 3 <br /> 7. Z : !^ °Z : c —I <br /> P .0 <br /> = s m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my `)i <br /> c p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofCL <br /> m <br /> all Information contained in this application(including any accompanying schedule)and I further declare that I recognize io <br /> that this information I am providing will be relied upon by the County of Bumett Wisconsin in determining whether to is- i m m <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 y <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection <br /> SIGN HERE `p <br /> (signature of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR � ) \tY� 1 tGt (1 s • • • . 40 <br /> 1066666 <br /> H40H40fn� <br /> N N N N N N N <br /> ut P ONN OO <br /> TOWNSHIP PERMITS MAYBE REQUIRED 0 0 0 0 0 0 0 <br />