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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 64872 Office of Zoning Administrator v 0 <br /> APPLICATION FOR LAND USE PERMITS 3 Sv <br /> ' a <br /> c ��y <br /> i n V <br /> OWNERC `T LEPHONE — L-10 S p <br /> m <br /> O <br /> HOME ADDRESSca ein O A 1 <br /> d r m <br /> EMERGENCY/FIRE NUMBER ROAD NAME A K� 1CIO <br /> .. <br /> 1�hs Q43 <br /> LEGAL DESCRIPTION(see tax receipt) pe-I �y,�, S2(,35/"div lej (L} ( p_�jg <br /> n <br /> e <br /> co o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ CCESSORY STRUCTURE ADDITION- <br /> L1 <br /> DDITION a ' <br /> 5. <br /> N <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> �n N <br /> STRUCTUREIADDITION 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 T c. <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) r <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. S �o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE M n <br /> NORTH(N). N G <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. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 2. <br /> MUST BE SIGNED AND DATED BY THE OWNER. v I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CrI <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. I <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. CI T <br /> 6. 9 ' y C O N 3 <br /> Z : K <br /> O <br /> 7. y i nl <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Zi c f A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of o E S <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize 1° m ' . . m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is <br /> ' ; ' O <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 application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized p rson to have access to the above described premises at any reasonable time for the purpose of Inspection. m <br /> m : <br /> n W i <br /> w : <br /> SIGN HER ' <br /> g-fta!0 of owner or b Iding contractor) D� (date) YJ; <br /> ZONING DMI ISTRATOR — <br /> fA iNiR'AfA fA <br /> N N to N N Mu 1 <br /> j, u• NONpOO <br /> TOWNSHIP PERMITS MAY BE REQUIR 0 00 0 0 0 0 <br />