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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Attr inistrator" 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3 0 r� <br /> N » <br /> TL <br /> C <br /> OWNER N �1� s�f,p LL TELEPHONE <br /> lir <br /> HOME ADDRESS 4/640/ An/V <br /> o <br /> EMERGENCY/FIRE NUMBERS/ 7 ROAD NAME <br /> I <br /> LEGAL DESCRIPTION(see tax receipt) L/5 T L/ ��1 ��` }a��� R <br /> e <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION C ' <br /> S. <br /> S.N <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION- <br /> STRUCTURE/ADDITION <br /> UBDIVISION STRUCTURE/ADDITION USE: E3 <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 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 <br /> �Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 'o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> NORTH(N). co 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m v <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. <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. o' <br /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE Cr ° Su <br /> ISSUED. a <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c ) <br /> CONDITIONS OF PERMIT: 0 <br /> t. 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. _ lVe / ' >` 4 A-c'�cC Al jer-a.�Ju s `f�l+iv �)e lW1CLQ l c �e�s f Meuse � v a o 0 9 <br /> htC4.C�� �d l oL+S c r <br /> _ Lu! (04 t-vC�iltQl ovnn"*Q' Q-�I/c�lic/^cot:ro Larey�o)u'l �S-c7 %a t� �a!S � Ss. � 3 a � <br /> Zi ;a/r O co: i Itl <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my C' C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of a <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- ? m D <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 d <br /> providing in this application. 1 agree to permit county officials charged with administering county ordinances or other E m E E <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> m : <br /> m : <br /> iu <br /> SIGN HERE .� ` <br /> (s nat re of ow�er�r�building contractor) (date) <br /> ZONING ADMINISTRATOR -='/�fi�ycl�i fn <br /> wwwwufx� <br /> V• O Vt Vt O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED O o c o 0 <br /> o000000 <br />