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Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator /M C _ <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> i ^' 0 <br /> OWNER K JQi� �" TELEPHONE S)> <br /> HOME ADDRESS7d0 ° <br /> 7 �/iSo7 L�C f2 O <br /> 8U7b ° <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) 410 a <br /> ,(I10rJ' / /�/n I <br /> 7th q <br /> TYPE OF PERMIT(S). DWELLING/BUILDING ii <br /> GARAGE/ACCESSORY STRUCTURE gDDITION C ' <br /> Cr <br /> Q! <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT-SUBDIVISION- <br /> 0' <br /> co <br /> STRUCTURE/ADDITION USE: :�/L/_s.rn� ® 0 <br /> ��rrr n n- 6 l <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) v 1 <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> DIRECTIONS FOR P OT PLAN DRAWING: (AERIAL OR TOP VIEW) A S lol— <br /> Z 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. O <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO M v <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- G <br /> INGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. O <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. S ol <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE a W <br /> ISSUED. �J <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITION Z OF PERMIT: u <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT I i <br /> ISSUANCE. <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 /> NO STRUCTURES, INCLUDING RETAINING WALLS, <br /> 4 PONDS, RIVER UNLESS SPECIFICALLY PERMIITTED.TC.,ALLOWED WITHIN 75 FEET OF THE OHWM OF LAKES, <br /> 5. <br /> 6. � ' O�Q�yyj qqOk£O£ 11 <br /> � n763F g'IT <br /> 7. 0� IC <br /> e : n o : <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my I ` m <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accurecy of <br /> all Information contained in this application(including any accompanying schedule)and I further declare that 1 recognize ^'' ' m S A <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to recognize <br /> �' E 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 Is ` ^� <br /> providing In this application. I agree to permit county officials charged with administering county ordinances or other ° <br /> authorized person to have <br /> ac <br /> to the above described premises at any reasonable time for the purpose of Inspection. m <br /> 7O ° <br /> SIGN HERE � _ ° <br /> " C [ � � M : <br /> (signature of owner or buil contractor) Z(date) <br /> ZONING ADMINISTRATOR ��' <br /> NH M(e N+ <br /> N NN NNtm <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />