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uN COMPUTEJSCANNED on ea -/- <br /> Burnett County 7410 Co. Rd. K No. 102' Siren WI 54872 Office of Zoning Administrator Q o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> N 0 <br /> ` ur <br /> OWNER /2r�u rC9 TELEPHONE <br /> v <br /> 93 <br /> HOME ADDRESS S� �YIF <br /> G 7o <br /> EMERGENCY/FIRE NUMBER n � � <br /> ROAD NAME <br /> 5 " <br /> LEGAL DESCRIPTION(see tax receipt) Ily �� �r� /�ii/ ✓ (�/7 r , / W <br /> W <br /> TYPE OF PERMIT(S):DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE CL <br /> S.y <br /> c <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION H <br /> �- d `D <br /> STRUCTURE/ADDITION USE: e 2. <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) 1 <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 3 <br /> DCI <br /> IRECTIONS FOR PLOT PL6N ARA�,I��r (AERIAL OR TOP VIEW) O <br /> T <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 2! Z <br /> 23 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE mW <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO tytt v <br /> LAKE,CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF L <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- C <br /> INGS, ROADS, LAKE, LOT LINES. Cj <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 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE q 0 <br /> ISSUED. <br /> n <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS 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 V �J <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. <br /> 6. m m iu t7 L <br /> )p,� 3 % % <br /> 7. H c a �too 3 <br /> —Cn '• <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of myrh <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m E <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize mm . <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- p <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 cials charged with administering county ordinances or other o f i <br /> authorized person to have es t the abov de cribed premises at any reasonable time for the purpose of inspection. <br /> Q m : <br /> SIGN HERE <br /> (sl nat a owner or bulldlog contractor) (date) <br /> ZONING ADMINISTRATOR <br /> jr w w w u w <br /> DIU NNN W Gm <br /> NOP5"P P <br /> OWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />