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Ch <br /> -IT <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872Office of Zoning Administrator 00 0 Z <br /> APPLICATION FOR LAND USE PERMITS _ < ° <br /> r <br /> rA <br /> OWNER //�►�� L //�J c <br /> l l k P f��j(�j f(� TELEPHONE �00 21?e DLSY`3 <br /> v v <br /> S <br /> HOME ADDRESS r�l L! l) F. <br /> /RG�esle yy)eu Ss qe) O <br /> EMERGENCY/FIRE NUMBER 17�Z/3 J J„r J� ` <br /> ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) <br /> o 1 <br /> Ll <br /> TYPE OF PERMIT(S):DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTUREADDITION C <br /> c <br /> or <br /> CL <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> ca <br /> STRUCTURE/ADDITION USE: �p Ilk � �N"f'wa/ I <br /> 1. <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) G <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> w <br /> DIRECTIONS FOR PLOT a)AN DRAWING7 (AERIAL OR TOP VIEW) C <br /> -n n C <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 f <br /> NORTH(N).3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDINGS)TO ALL LOT LINES, (B)BUILDINGS)TO m �3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, <br /> STREAM OR RIVER. Z <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILD- c <br /> INGS,ROADS, LAKE, LOT LINES. * W <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 t <br /> MUST BE SIGNED AND DATED BY THE OWNER. c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE a 0 <br /> ISSUED. <br /> 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z .. 1 <br /> CONDITIONS OF PERMIT: c <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. I <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. C) <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 /> aa N! <br /> 7. � : 91 ,C cm3 <br /> o aqi 1 <br /> -y: M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my � <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of 'm r r <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize C 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 ^� <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 a4aye described premises at any reasonable time for the purpose of inspection. <br /> m E <br /> o : <br /> SIGN HER <br /> ign re of ow building contractor) (date) <br /> c <br /> ZONING ADMINISTRATOR ' <br /> 4a'40 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 <br />