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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator v�-�o ,o <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> 0 <br /> OWNERTELEPHONE 79� <br /> HOME ADDRESS 51 1O1 I k J I�R M a <br /> EMERGENCY/FIRE NUMBER �3 Y ROAD NAMES <br /> _ o <br /> LEGAL DESCRIPTION(see tax receipt) � � � � ,� � <br /> c C o �U C—i <br /> y <br /> 0 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE DDITION <br /> cr <br /> v <br /> n ( 11 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION- <br /> Iwo <br /> UBDIVISION uJ \J <br /> STRUCTURE/ADDITION USE: V- a � Lk 2 <br /> r. <br /> (Home/Cabin;6immercial Business;Bedroom;Deck;etc.) � SI I <br /> � 1 <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> 0 w <br /> DIRECTIONS FOR PLOT PLAN DRAWIN 7 (AERIAL OR TOP VIEW) p l2pP <br /> n C <br /> ?i O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 M '0 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m IF <br /> NORTH(N). C a <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, lJ 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. N <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. m o <br /> o 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BEa 0, ( ,, <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z l�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 /> A -0nr- a <br /> 6. 3 a O. ;M0v ? R m c <br /> 7. Z : w <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my cqi i 0 <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of UCE d i c <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. I agre4,,to permit county officials charged with administering county ordinances or other m <br /> authorized person ave access to thWVoveSkscribed premises at any reasonable time for the purpose of Inspection. <br /> n : <br /> m <br /> SIGN HERE — yr ' <br /> (slq'Kafyre of oviner or building contractor) (date) <br /> ZONING ADMINISTRATOR 1 C e4—i)E <br /> HhHh�h� <br /> N N(TNNNtn <br /> Vt OHO Vt iT00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />