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U1 �, <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. 4 <br /> r <br /> rA o <br /> OWNER �^ v�i' /Lf, /�� ��TELEPHONE <br /> `J�Q M r t vim✓ O \ QO <br /> 3 Wf} <br /> HOME ADDRESS r H ) �Ol� � <br /> 0 N <br /> EMERGENCY/FIRE NUMBER 7 ROAD NAME I <br /> Arty ✓ Y� <br /> ,u/Ll <br /> LEGAL DESCRIPTION(see tax receipt) y <br /> e <br /> w � <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION or <br /> Q: <br /> S. <br /> w <br /> SANITARY PRIVY ++'' FILLING/G/R•ADING CAMPING UNIT1/ SUBDIVISION- <br /> o" <br /> STRUCTURE/ADDITION USE: 3Y X 30 l/Iyl litAfea- ID ' 30 UBck r L <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. r. <br /> DIRECTIONS FOR PLOT PLAN DRAWING- (AERIAL OR TOP VIEW) p o <br /> " a <br /> In Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m � jp <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m �o <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER. I 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. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS S <br /> MUST BE SIGNED AND DATED BY THE OWNER. n u <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 0 S }' <br /> ISSUED. (()�� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOWn <br /> CONDITIONS OF PERMIT: ON C. O. <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 <br /> crz; SPEC1F�ICzL(Ll�ERMIT`TED./, <br /> 7 //5. <br /> `266. �1 <br /> C7 <br /> ;q -0 n m 0� ii f 1Cm <br /> ` w <br /> 7. o <br /> _ca m <br /> I declare that this application (including any accompany g 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 of m � ? S C <br /> all Information contained in this application(including any accompanying schedule)and I further declare that I recognize ' m m ; 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 10m <br /> providing In this application. I agree to permit county officials charged with administering county ordinances or other 902, <br /> E E <br /> authorized person to have access to the above described ny reasonable time for the purpose of Inspection. m E <br /> m : <br /> w : <br /> SIGN HERE <br /> (aline of nor ntractor) n L:� ' j..._.:.._,.... <br /> ZONING ADMINISTRATOR E h <br /> VI i/I VI iN W 4N <br /> N "0 N N 0 U� <br /> � V•O�CTOO <br /> OWNSHIP PERMITS MAY BE REQUIRED 1� _ 0 0 0 0 0 0 0 <br /> A <br />