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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator - oc, <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> OWNER TELEPHONE <br /> HOMEADDRESS 7 V pZ 9 /` Ly % � �f1G�}A/ In AJ &S'lo?a U 0 <br /> i, O f0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME aj t LLOLf1 R E .. — <br /> LEGAL DESCRIPTION(see tax receipt) <br /> v, o <br /> TYPE OF PERMIT(S):DWELLING/BUILDING y GARAGE/ACCESSORY STRUCTURE ADDITION Q ' <br /> a <br /> S. <br /> SANITARY RIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> '/ m <br /> STRUCTURE/ADDITION USE: I� <br /> -i <br /> (Home/Cabin; Commercial Business;Bedroom;Deck;all.) •"y <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. r <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 <br /> m Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m S <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m j 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- Sb <br /> INGS, ROADS, LAKE,LOT LINES. I `� <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. 1_. m o <br /> b' o (),1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 5 <br /> ISSUED. 2 <br /> I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT oo <br /> IN <br /> ISSUANCE. G' <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 /> s. GuJ� e& ` I / '6j1 Card a, c I �� <br /> 7. . r. <br /> �e eget , ufl� a z 1 <br /> A <br /> I declare that this application incl in an accompanyingschedule has been examine me and o the best of m ((..,, m <br /> PP ( 9 Y ) <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for eCtail and accuracy of ; n <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize o m <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <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 <br /> authorized person to have access to the above described premises at any reasona for the purpose of Ins ectlon. -n <br /> , :, -� i <br /> r- <br /> w . <br /> SIGN HERE <br /> (signature of or or building contractor) I (d�' <br /> ZONING ADMINISTRATOR ) I ' Z 7 • . • .40 fo 40 <br /> . <br /> N N N N N N N <br /> N N O N N O CC <br /> ..._ 0 0000 00 <br /> TOWNSHIP PERMITS MAY BE REQUI ED 0 0 0 0 0 0 0 <br /> uI�c <br />