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eayy- <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v/M L G] <br /> APPLICATION FOR LAND USE PERMITS <br /> ^� r <br /> F o <br /> w <br /> C <br /> OWNER , TELEPHONE <br /> of <br /> m <br /> HOME ADDRE41 <br /> c- <br /> 0 <br /> 0 <br /> EMERGENCY/FIRE NUMBER _q(� � ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) <br /> c <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE <br /> ADDITION- <br /> SANITARY- <br /> DDITION SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0• <br /> � �^ y <br /> STRUCTURE/ADDITION USE: d of ,b'b'fl � <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> w <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) O m <br /> n o <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m M :b2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> It <br /> NORTH(N). <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, 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. 1 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS I <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> v 0j <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 0 <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: c <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 /> ;a = m m 0 0 M <br /> 6. � a3 aQ <br /> Cw C o <br /> 7. o FaQ =mi <br /> .y: <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c p <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that 1 am responsible for the detail and accuracy of m C <br /> all information contained In this application(including any accompanying schedule)and I further declare that I recognizem m <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- d 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 d <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m E E <br /> authorized person to ve access to the above described premises at any reasonable time for the purpose of inspection. m E <br /> p � <br /> SIGN HEREG �- l 6 N <br /> (signature of ner or building contractor) (date) <br /> ZONING ADMINISTRATOR �����I <br /> NNNN6IN� <br /> N N[ <br /> U N O VtUOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />