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Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 Z <br /> APPLICATION FOR LAND USE PERMITS 4 ° <br /> J 1 /� w <br /> ° C7 <br /> OWNER �eC� hlp'ra—b �J' TELEPHONE $ <br /> HOME ADDRESO <br /> S yq�p Anda l I r )11� m, l � <br /> 1 ,v <br /> EMERGENCY/FIRE NUMBER ROAD NAME _ �f <br /> 1 I <br /> LEGAL DESCRIPTION(see tax receipt) C <br /> TYPE OF PERMIT(S):DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION c 0 <br /> 3 L <br /> cr <br /> L <br /> 5. <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION- <br /> STRUCTURE/ADDITION <br /> UBDIVISION STRUCTURE/ADDITION USE: �J/ I t i I� , <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) z 1 <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR T 3 C <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> 0 c <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) 0 <br /> 21Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m O � :b2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). a n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDINGS)TO M 3� <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER. o <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. 12 r 'l <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 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. <br /> ,o o <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE5 °, jy Lo LU <br /> ISSUED. <br /> (a 0, <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z9IJ <br /> CONDITIONS OF PERMIT: I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. Vj <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY wcp <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 /> ;a 6. , 10 <br /> a <br /> � m <br /> v C w w p7. <br /> 3 <br /> w <br /> rn <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c pm <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofm E : C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize ro m <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 d <br /> providing In this application. 1 agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. <br /> w : <br /> SIGN HERE 40 : <br /> (signature of owner <br /> roojrabuilding contractor) (dam) <br /> ZONING ADMINISTRATOR ` )1(y) 1 IU'I 11 Q J n <br /> N)hN{e HhL" <br /> N NfIlNNU1 Vt <br /> V1 ut O ul V7 O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />