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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - v Z <br /> APPLICATION FOR LAND USE PERMITS I. 4 <br /> r <br /> o <br /> OWNER " <br /> ' C. TELEPHONE <br /> I m <br /> HOME ADDRESS <br /> la 0? 11042�i.,Q�. .,d�(,i (3) <br /> EMERGENCY/FIRE NUMBER ,2 7 7,f j ROAD NAME C <br /> z7/01 .RG 4/13 st? <br /> LEGAL DESCRIPTION(see tax receipt) Sri�` TYO / � •.qC j^CS � 3�Q ! <br /> 0 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> or <br /> CL <br /> SANITARY5 <br /> PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o' <br /> uJ <br /> STRUCTURE/ADDITION USE:__Ced� =- R <br /> lir <br /> m® 5 <br /> (Home/Cabin;Commercial Business;Bedroom;Deck:etc.) 9 � <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. _ <br /> O —� <br /> DIRECTIONS FOR PLOT PLAN DRAWING- (AERIAL OR TOP VIEW) MSn <br /> � <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m i <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, <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- o <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 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 0 I � <br /> ISSUED. Cr S " 1 <br /> 7 I 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z l_JI v <br /> CONDITIONS OF P RMIT• 0 (� <br /> I <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 OH OF LAKES <br /> 5. , <br /> PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 6. Mmor v�vv <br /> �qiEekF m <br /> C <br /> 7. <br /> q <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my m <br /> c <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize CO 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 /> 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 /> providing in this application. I agree to permit county officials charged with administering county ordinances or other `a <br /> authorized person to have access to the above described premises at anyreasonable time for the purpose of inspection. P <br /> T : <br /> SIGN HERE <br /> (sign re f nor o In ontractor) .J7 (date) <br /> ZONING ADMINISTRATOR <br /> N NN N NtrN <br /> (n i7�O Vt to 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED ca 0 0 0 0 0 0 0 <br />