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em 0 <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 5 <br /> w <br /> OWNERCL/I/CCN Gl //S!` L�CL�SII/ /6�0� ry�Cf7�73v� <br /> ,(� TELEPHONEC � ^p <br /> HOME ADDRESS <br /> EMERGENCY/FIRE NUMBER 9 y�� ROAD NAME ' OECD CA <br /> .. <br /> LEGAL DESCRIPTION(see tax receipt) (a <br /> Q <br /> ca 0 <br /> TYPE OF PERMIT(S):DWELLING/BUILDING ✓ GARAGE/ACCESSORY STRUCTURE ADDITION n <br /> w- <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> r / y <br /> STRUCTURE/ADDITION USE: <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. 7C0 w <br /> w 00 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) r CL <br /> _n G Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 'o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE rnc <br /> NORTH(N). <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, 1 c <br /> STREAM OR RIVER. <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. v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE `" o <br /> ISSUED. I <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 1 <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. a � 7J � m m3 CLfflom <br /> no 171 /�t �(cr✓►rOl Cov/�ICCr' �l es �' o , RQ ; '° <br /> 7. _ <br /> /,1 m <br /> I declare that this application (includingan accompanyingschedule) has been examined by me and to the best of my �'i G� fJ <br /> knowledge and belief it is truecorrect and cmplete. I acknowledge that I am responsible for the detail and accuracy of E C <br /> CL <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m G <br /> N€ i <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 ro <br /> authorized person to"ve access to ths,9bove described prernises at any reasonable time for the purpose of inspection. <br /> m : <br /> SIGN HERE <br /> (sig ofowi r or buil g co for ( ) E <br /> /p 9 ( € <br /> ZONING ADMINISTRATOR �w to ww <br /> ra �n 0 <br /> TOWN IP PERMITS MAY BE REQUIRED o 0 0 0 <br />