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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator V/9 o r o <br /> APPLICATION FOR LAND USE PERMITS . 4 <br /> OWNER ELEPHONE <br /> S <br /> HOME ADDRESS L�Q 9 <br /> EMERGENCY/FIRE NUMBER ROAD NAME ( 7 <br /> (� C <br /> LEGAL DESCRIPTION(see tax receipt) /T /�� L O���Qs-m Vu I 3. nc �,('(1 I Q <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTUREDDITION Q <br /> Q! <br /> S. Q t <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> a. ivy <br /> N <br /> STRUCTURE/ADDITION USE: �� g <br /> (Home/Cabi(;Commercial Business; Bedroom; Deck;etc.) y i <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR G <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m <br /> A G <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). H Cq _ 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO rl a <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER. P <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILD- 9-) <br /> INGS, ROADS, LAKE, LOT LINES. p0 <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 /> 4-- <br /> MUST BE SIGNED AND DATED BY THE OWNER. a'o at <br /> _o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE m °, <br /> ISSUED. 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c I <br /> CONDITIONS OF PERMIT: w <br /> 1 <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, RCIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. he A/_ I eL10Tf r-j-or-_ )3,j S W,,e �. <br /> p v 0 r O O -0 <br /> 6. <br /> m <br /> 7. P i ai` m`C i M <br /> N <br /> M <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my C <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of 'w <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 Bumett Wisconsin in determining whether to is- ? m ' ' a <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 <br /> providing in this application. 1 agree to reit county officials charged with administering county ordinances or other <br /> authorized pens n to have access to th a ove described premises at any reasonable time for the purpose of inspection. .n <br /> n <br /> SIGN HERE <br /> I alu of owner Idl contractor) (date) <br /> ZONING ADMINISTRATOR <br /> . W <br /> N N O O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED o o'o 0 0 0 <br />