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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS a 4 <br /> lJ, <br /> 0 ' n <br /> N � <br /> C <br /> OWNER 11f y/]I ay, / R�S� TELEPHONE <br /> HOME ADDRESS �a� l.T . L L 1 �� D,e��E�f WgaeV, Ulf 5IM3o- �'^n) <br /> �� � � r. V) 9 <br /> EMERGENCY/FIRE NUMBER 46,.26 7 ROAD NAME �l�I LL Rl�/�' } vml <br /> E /6S:5'Of W 4014.1 5r SE <br /> LEGAL DESCRIPTION(see tax receipt) S 3I61 T 41 b o) <br /> v. <br /> )n <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTUREADDITION c <br /> a <br /> 5. <br /> N <br /> SANITARY PRIVY FILLING/G/RADING CAMPING UNIT SUBDIVISION <br /> to <br /> STRUCTURE/ADDITION USE: <br /> Oa <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) a <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR m <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. _ <br /> M 8 <br /> DIRECTIONS FOR PLOT PLAN DR WING (AERIAL OR TOP VIEW) p <br /> CL <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m S <br /> NORTH(N). <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(OHWM)OF LAKE, 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. <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 0 ( 1) <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE a 0, <br /> ISSUED. o <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: /ori <br /> J V 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ,(/1 II <br /> ISSUANCE. Uj <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 /> z � 23 o vv <br /> 6. <br /> 3n i <br /> TO <br /> � � , 0 <br /> v I0 'Q� - <br /> 7. o � CQ : <br /> C) <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my E A <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m 'r i i . C <br /> all Information contained in this application(including any accompanying schedule)and 1 further declare that 1 recognize m m m <br /> that this Information I am providing will be relied upon by the County of Bumett Wisconsin in determining whether to is v <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information 1 am m' <br /> providing In this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> m <br /> SIGN HERE <br /> (signature of owner or by9hing contractor) (date) �J. <br /> ZONING ADMINISTRATOR ' <br /> i E i <br /> t MMNNiA� <br /> (Nr10 Np 00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED0 0 0 0 0 0 0 <br />