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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> IV-PC,2-(1-59t,131 o <br /> N <br /> 6rCIZ '776 33ya <br /> OWNER TELEPHON,ah K !S YIci <br /> o <br /> m �} <br /> HOME ADDRESS CJ ,3 an I <br /> EMERGENCY/FIRE NUMBER ROAD NAME 1�Q r ST o T <br /> ( P) . 's /a�.'� �: of Aidlow 10, 0. <br /> LEGAL DESCRIPTION see tax receipt) A w <br /> Y r m <br /> SIX 11 EX,315 o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION �x� <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION V' <br /> ur <br /> STRUCTURE/ADDITION USE: Q <br /> (Home/ bin; Commercial Business; Bedroom; Deck;etc.) <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 0 �j <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). y O O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m O 3 <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, o <br /> STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. — <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. N I <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 /> v � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE q <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. P I <br /> CONDITIONS OF PERMIT: <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 /> zvW = 0vCvm <br /> M <br /> 3 a m OX n � <br /> OLD* c <br /> 6. a : CDCviyoJ3 <br /> N N O O 0 <br /> 7. o <br /> ',—cn: m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 3 c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of ; o <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize CD m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- y O <br /> sue a permit. I further accept all liability which may be a ul r on this information I am io <br /> providing in this application. I agree ermit coun ffi e t o ty ordinances or other m <br /> authorized person to have access above d d i I ti h purpose of inspection. T <br /> m <br /> SIGN HERE <br /> (signature of ow or bullding c tor) v ' (date) <br /> ZONING ADMINISTRATOR I(Y\ [ It�(144r rowrcrr r+ni lblTV �+ <br /> J N N N M M <br /> !Ln o <br /> ZONING P <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />