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Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator 'a o 0 <br /> APPLICATION FOR LAND USE PERMITS a 4 <br /> ` - r <br /> N <br /> OWNER �J (1 � TELEPHONE 63,5- 9qL1 o <br /> m — <br /> HOME SS I V lq UD ��l]6f ' I <br /> /��d� � <br /> mn o W <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> 1 <br /> LEGAL DESCRIPTION(see tax receipt) 66t, W I Ser <br /> / I <br /> ur <br /> o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION 0<3 <br /> a _ <br /> E• <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> STRUCTURE/ADDITION USE: <br /> c6m V �6 Pi � - /L/C <br /> y <br /> 3 <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) � <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m =� <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) OiP <br /> n a <br /> ?1 Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 10, <br /> ;b2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). N e <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. o <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. <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. 0' o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 0 <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: I <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 /> X -0 m d CD L q <br /> m <br /> 6. 3 a 3ca- x <br /> a mCNHo � 3 <br /> 7. Z : <br /> o : <br /> =y : M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my C <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofCL <br /> m <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize 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 result of the County of Burnett relying on this information I am m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m E <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. T <br /> CD : <br /> m : <br /> H : <br /> SIGN HERE <br /> (signature o ner or tilding contracto_r)) (date) <br /> ZONING ADMINISTRATOR I•� I �GrU 1 I "6;0: 000000 <br /> ` • ' w <br /> 44 HhtnH <br /> NLT N NN(!1 <br /> (T O V1 tT O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 <br />