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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator "St Z <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> N w <br /> OWNER dd1YlTELEPHONE <br /> HOME ADDRESS � 3 qM OCI <br /> - <br /> Y� <br /> EMERGENCY/FIRE NUMBER �� ROAD NAME A, I I f?A, <br /> U <br /> ,�.; „ , Q t <br /> LEGAL DESCRIPTION(see tax receipt) G 0 V L� a \ Sec ����(�/� I��+U'j c <br /> N <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION ii <br /> a <br /> S. <br /> N <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION—k <br /> STRUCTURE/ADDITION USE: V, lir <br /> (Home/Cabin; Commercial Business;Bedroom; Deck;etc.) T <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 /> x N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T <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 <br /> NORTH(N). y o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OH WM)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- DLj�o <br /> INGS, ROADS, LAKE, LOT LINES. l <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 0 -� <br /> MUST BE SIGNED AND DATED BY THE OWNER. m o 4 <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BEq 0 <br /> ISSUED. (n0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c "J <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 /> p = 0r oeo � <br /> a <br /> sdm <br /> 6. '� 9 Cw o S3 <br /> o :VI ii <br /> =co m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my a5 c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of d <br /> all information contained in this application(Including any accompanying schedule)and I further declare that I recognize ' am '. ;a <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 officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. T <br /> m : <br /> e : <br /> w : <br /> SIGN HERE <br /> (signature of owner or building contractor) (date) , <br /> ZONING ADMINISTRATOR V I/Yl Oan)Gjao w <br /> N NU1NNfl1 U1 <br /> (71 (71 0(71 f71 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />