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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -00 C� , <br /> APPLICATION FOR LAND USE PERMITS . <br /> N 0 <br /> OWNERJo kA) 74 eLnp TELEPHONE <br /> 1 • r V" <br /> HOME ADDRESS aj6-W �en;um L��e IV;L�'Jo �� � � <br /> EMERGENCY/FIRE NUMBER ROAD NAME �A et <br /> LEGAL DESCRIPTION(see tax receipt) �o-t ' 4J ScC so T z( t tPu IQ iso Boers Ile 0 -7- <br /> ca y <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE1--ADDITION v <br /> n <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> - <br /> ch <br /> c"� <br /> STRUCTURE/ADDITION USE: � ,e4 &' <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O 3 <br /> ;0 a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 071 <br /> cy� <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m� z <br /> �A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). N ` c <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m v <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, <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. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS r <br /> MUST BE SIGNED AND DATED BY THE OWNER. m' o �k✓Jr <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 3 <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: c .Y✓ <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 /> � 79 <br /> 6. � a o' _ � <br /> ! Cw o <br /> 7. o !n I 'm 1 <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m m <br /> PP ( 9 Y ) Y Y ID <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of I o <br /> all information contained In this application(Including any accompanying schedule)and I further declare that I recognize �' ® m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Is- d O <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 (JI m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized pe have access to th ve described premises at any reasonable time for the purpose of inspection. n <br /> o : <br /> / m : <br /> SIGN HERE <br /> (signs a of owner or building contractor) (date) w <br /> j� iON <br /> ZONING ADMINISTRATOR VI/Yl I IC�(�1Gilfl ° w <br /> N W 404M4R 40 <br /> N NU N Ntn tli <br /> V7 V7 O V7 Vl O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />