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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator -uo <br /> APPLICATION FOR LAND USE PERMITS 4 <br /> r <br /> w o <br /> OWNER "'_)C"(?C7, �f�rG� f—r J _V TELEPHONE v <br /> HOME ADDRESS yy p nd�' I �r )�� I MAJ L � <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> 1 <br /> LEGAL DESCRIPTION(see tax receipt) S <br /> ca <br /> 0 f. <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION ii N 0 <br /> V <br /> a <br /> S. <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISIONL o <br /> I <br /> m Y <br /> r� <br /> . <br /> STRUCTURE/ADDITION USE: � <br /> (Home/Cabin; Commercial Business;Bedroom;Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR C <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. r. <br /> c <br /> DIRECTIONS FOR PLOT PLAN D AWIN 7 (AERIAL OR TOP VIEW) 0 � <br /> n v z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m ;b2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). I_- n <br /> cc 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m a <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, 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. <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 /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE <br /> ISSUED. Cr <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 2 V kJ I <br /> CONDITIONS OF PERMIT: ° <br /> r <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. p ' 30. om <br /> wow ' ; <br /> o <br /> 7. <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of ` C <br /> CL <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize mi i ': 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 m <br /> providing in this application. 1 agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. n <br /> SIGN HERE ' <br /> (signature <br /> of ownerorbuilding contractor) (date) <br /> ro <br /> ZONING ADMINISTRATOR )1!Y) 1 aflIU6n E d, <br /> N fA fA fA fA fA <br /> N N Vt NN V7N <br /> Vt pi0 i71N00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />