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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 O Z <br /> APPLICATION FOR LAND USE PERMITS 3 t ° <br /> r <br /> OWNER / /,0. ►��� T =SCQ\� TELEPHONE( 7/S / 3J — a�(� m <br /> HOME ADDRESS 1O L <br /> o <br /> EMERGENCY/FIRE NUMBER 416 ROAD NAME `\ <br /> LEGAL DESCRIPTION(see tax receipt) S00—MW J ec 'T Ltl N : R m <br /> � M o <br /> o <br /> TYPE OF PERMIT(S):DWELLING/BUILDING ARAGE CCESSORY STRUCTURE�ADDITION <br /> �24 �Y� yr a <br /> 5. <br /> w <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> Cl) <br /> W <br /> STRUCTURE/ADDITION USE: fir <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) _q <br /> M <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR it <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m 3. <br /> 0 w <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T r <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 0 :b <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <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. o <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. n ` <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS SCJ <br /> MUST BE SIGNED AND DATED BY THE OWNER. nn m c QQ <br /> QVv J O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE Cr <br /> W <br /> ISSUED. n <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> W <br /> CONDITIONS OF PERMIT: c <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT x J I <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. ��A/ �q�� /�7� �^ \ W1 <br /> 5. � ��.011 p pGt'i"tt 1"_ Cr J e uJ /µw„ '" (1G T R� / „ 1 0 v C)r 0 9 <br /> s. (q'e Of— cell-land• R. 'Oro 0 <br /> o <br /> J Iwo : =m3 <br /> 7. o : yM Q <br /> o : <br /> =y: <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ti ID <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of w c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m <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 m E <br /> authorized person to have access to tile above described premises at any reasonable time for the purpose of Inspection. T <br /> w : <br /> 0 : <br /> h : <br /> SIGN HERE <br /> (sl roof owniyopbulldco c ) d te) <br /> ZONING ADMINISTRATOR (/�lJ V1. . • • • . w_ <br /> N Nf�JNNt�7�fn <br /> FF <br /> N N O N N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED d co 0 0 0 0 0 <br /> 0000000 <br />