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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872N ��� <br /> APPLICATION FOR LAND USE PERMITS Office ofning Administrator 3 0 0 <br /> r <br /> 0 <br /> c <br /> OWNER ,ifs ` TELEPHONE _1 Z Sy.- `5 3 aIr <br /> �n <br /> HOME ADDRESS '1 / <br /> EMERGENCY/FIRE NUMBER 2 jf/�(,) ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) I y <br /> m <br /> k n <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION_ ti <br /> c <br /> c <br /> CL <br /> 5. <br /> SANITARY PRIVY FILLING/GRADING CAMPINCy U IT S DIVISIppN L <br /> / X�— e 4 Jl0 lac. 00 J <br /> STRUCTURE/ADDITION USE: [ / In <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR R <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. In ^; <br /> 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. T C Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m 0 ;b <br /> NORTH(N). a 0 <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, 1 Z <br /> STREAM OR RIVER. c <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. I <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 <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 v 0 <br /> ISSUED. r ° <br /> St <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> �v 7l <br /> CONDITIONS OF PERMIT: P c <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 OHWM OF LAKES, <br /> PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. <br /> 6. ��O'/ X ski Wil/ l r -�//,���,,.. C.� �r A n r yO G 9 <br /> XM <br /> l. <br /> 7. <br /> 0. 0Z � � � -I <br /> 1�: <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my pm <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of a C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m <br /> that this Information Ia providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- E p <br /> sue a permit. I further c ept all liability which may be a result of the County of Burnett relying on this Information I am m <br /> providing in this appli atf n. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to hovif access to the b e des ribed premises at any reasonable time for the purpose of inspection. <br /> - : <br /> SIGN HERE (/� — f^ '• <br /> ( ` re of�ojwlner o r bull ing conVactor) (date) i <br /> ZONING ADMINISTRATOR JIf11 I Iv7lt�� �E <br /> wwww�fn� <br /> N NiTNNfJ1 Vt <br /> N NO V7 VtOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />