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01 CPYIT <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -V 0o <br /> APPLICATION FOR LAND USE PERMITS . 4 <br /> r <br /> N .. <br /> C ji <br /> OWNER TELEPHONE <br /> d <br /> HOME ADDRESS S1_ ,dam SLLo1�f W'-Ne A44 <br /> 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> 0 <br /> G <br /> LEGAL DESCRIPTION(see tax receipt) #2 CS W Il. /� e�. 9 S SLD I <br /> L 2 V—YQ —lq ,carrel #J-- - -7- o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTUREL'� ADDITION c <br /> o <br /> S. ww <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION <br /> U) <br /> m <br /> STRUCTURE/ADDITION USE: R <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 /> ,n <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> 7x11 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O S. <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 'q <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> NORTH(N). N 3 <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, Z <br /> STREAM OR RIVER. ° <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILD521 <br /> - <br /> INGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N 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. m c <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE cr ° XJ <br /> ISSUED. Et <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT l <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 /> o. m <br /> �, N OCO <br /> O�O <br /> 7. o �I Z <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my O cq ; C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of a <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize (D m <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- '. 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 cials charged with administering county ordinances or other m E <br /> authorized person to have access to the above descri d premises at any reasonable time for the purpose of inspection. n `: <br /> M : <br /> SIGN HERE l o:7_eA <br /> (signature <br /> of own r or buildln4 contractor) (dy e) <br /> ZONING ADMINISTRATOR <br /> N N V t N N N u t <br /> Vt NO Vt Ut OO <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />