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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 0Z <br /> APPLICATION FOR LAND USE PERMITS It <br /> w <br /> OWNER �L� l �. Sf�yc [��^ TELEPHONE �(fQ ,�_3� a <br /> � �i 1 �7�yy � <br /> HOME ADDREro� <br /> SS y LI \, /�/ %�J)C'r �AJh I`G�. Y U C�S��) �]7d`f <br /> EMERGENCY/FIRE NUMBER ][ Lr ROAD NAME / )h- �lo;. <br /> LEGAL DESCRIPTION(see tax receipt) / N( ��� S� ��L —T j,j'lu o <br /> � e <br /> C <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION or <br /> s: <br /> N <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> ��II uJ <br /> STRUCTURE/ADDITION USE: �'/�`'! / 4L) or <br /> (Home/Cain;Commercia(Business;Bedroom;Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR ,n <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> .'0 w <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> NORTH(N). C <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO rn 3 <br /> p <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. r <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 V <br /> MUST BE SIGNED AND DATED BY THE OWNER. a <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE Cr <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o w <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT C <br /> ISSUANCE. C <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. Q <br /> a 'rF ek <br /> n <br /> o <br /> 6. i w o o,o <br /> —mi `• i m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my es c i ID <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of E 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- 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 m <br /> providing in this a icatlon. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized persoh to Mave access to the above d*y&d premises at any reasonable time for the purpose of Inspection. m i <br /> N : <br /> SIGN HER <br /> gna roof own dl contractor) (date) <br /> ZONING ADMINISTRATOR <br /> N NCnN N Il1(1 <br /> P fn ON91 OO <br /> O 0 0 0 0 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />