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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator a G) Z <br /> APPLICATION FOR LAND USE PERMITS s <br /> ^� r <br /> w <br /> OWNER m � G� TELEPHONE <br /> m <br /> HOME ADDRESS t� j4 0 <br /> or. m <br /> EMERGENCY/FIRE NUMBER y U 0 ?W ROAD NAME <br /> ii—hG, �.frn rrJ1/]v n d <br /> 4- <br /> LEGAL DESCRIPTION(see tax receipt) 0-FS 1a, esm hyo) '�/ 33 Se 3 -�JU'-/Gj w -j <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION a M <br /> CrCL <br /> 5. <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISIO o' (J <br /> STRUCTURE/ADDITION USE: , fineC+�t <br /> Ite <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) -I <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR 3 C <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O O <br /> DIRECTIONS FOR PLOT PLAN DAWING- (AERIAL OR TOP VIEW) O o CD <br /> h a <br /> In <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. _G Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m 9 <br /> NORTH(N). C n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO M 9 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, v <br /> STREAM OR RIVER. Z <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILD- G <br /> INGS,ROADS, LAKE, LOT LINES. SLD <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <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. c W <br /> v � � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE <br /> ISSUED. g <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z .. O W <br /> QONDITIONS OF PERMIT: P <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 SPECIFICyL Y PERMITTED. p L� / <br /> 5. SA'lult SIStem lorr,�w wAcf -b Jose rn6k_'�-C '0Meef 5Clq�Gcr�'(�Gu�e�^�O r <br /> 6. Q I �QC�GU.reC,(r �_.... 1 x - n r.- <br /> 1 QyyyyyQ qOq <br /> 1nNNa� A <br /> 9 , o>qt=w os3 <br /> 7. c w (COD� i =f° -1 <br /> .N i '• A <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my c ' A <br /> knowledge and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofm ` c <br /> all information contained in this application(including any accompanying schedule)and 1 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- G� C <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 ^' ' <br /> m : <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 /> m E <br /> SIGN HERE -� A-7- <br /> (signature of owner or building contractor) '(date) <br /> v` <br /> ZONING ADMINISTRATOR <br /> / 46404A40 N <br /> fNrl ,(N71 O.(Nil O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 <br />