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6rCT's <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o o <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> C::� <br /> c ilk <br /> OWNER R ` , T LEPHONE a <br /> $ O <br /> HOME ADDRESS YO L ) /e Je_Y,011AL AL � O ti 4 <br /> EMERGENCY/FIRE NUMBER(,( 7�S- Ll ROAD NAMET � a K*,, <br /> 411, 07- 03ex 3'-f4l- Ap-T(v <br /> r -�� f G <br /> LEGAL DESCRIPTION(see tax receipt) L S W w � P /O �c� Co <br /> o ^ <br /> m � <br /> TYPE OF PERMIT(S):DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION- <br /> or <br /> 5. <br /> �. <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> N <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <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. 00 w <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 $ <br /> t. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 g A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m n <br /> NORTH(N). W <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m a <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER. ° <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. �.1 <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. XJ <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 /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE q <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELO o <br /> CONDITIONS OF PERMIT: _ <br /> l <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 /> M .0 m r- <br /> 6.6. v C <br /> Zi <br /> 7. ° ` ' y m <br /> eclare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> lowledge and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of n <br /> Al Information contained in this application(including any accompanying schedule)and I further declare that I recognize o o I ; m <br /> khat this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- of y O <br /> Isue 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 m <br /> authorized person to have access jalbaAbgve described premises at any reasonable time for the purpose of Inspection. <br /> SIGN HERE <br /> (a D.rr r bhullding contractor) ( te) <br /> ZONING ADMINISTRATOR <br /> M NNW <br /> N N[n N ri NNN <br /> N Ofn NOO <br /> OO O O O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 0 0 <br />