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gp C <br /> Burnet"County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 G) Z <br /> APPLICATION FOR LAND USE PERMITS 4 <br /> OWNER <br /> TELEPHONE c <br /> m <br /> HOME ADDRESS — O <br /> EMERGENCY/FIRE NUMBER ROAD NAME Va I�d- <br /> I <br /> LEGAL DESCRIPTION(see tax receipt) W — L <br /> 11 <br /> LAW o) <br /> TYPE OF PERMIT(S):DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION I o <br /> C <br /> or <br /> CL <br /> 5. <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> -X 0 Z3- <br /> STRUCTURE/ADDITION USE: Osm <br /> (Home/Cabin; Commercial Business,Bedroom;Deck;etc.) —I <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR 9! <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 3 <br /> DIRECTIONS FOR PLOT PLAN DRAWING. (AERIAL OR TOP VIEW) 0 w <br /> O m <br /> -n a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. TZ <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m Ir <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, <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- <br /> INGS,ROADS, LAKE, LOT LINES. ` <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. T <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 6 <br /> MUST BE SIGNED AND DATED BY THE OWNER. m <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE a �N <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF P RMIT: P <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 /> 6. ;0 ' 3 2) <br /> a <br /> 9 w w e = Z <br /> C w : c 3 <br /> 7. , w �� <br /> P <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best —q <br /> of my �0 <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of 0) ` _C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize CL .m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to is- G7 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 amffi <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. <br /> - : <br /> SIGN HERE <br /> (siignn-attu-re of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR <br /> -�-• fA N fA N(A W�+ <br /> N NfJINNNN <br /> (J1 NONUtOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />