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Burnett County 7410 Co. Rd.K, No.102,Siren,WI 54872 Office of Zoning Administrator � 0 Zj <br /> APPLICATION FOR LAND USE PERMITS < <br /> ^� r <br /> 0 <br /> OWNER t ou)ARN tW r TELEPHONE Qq <br /> HOME ADDRESS 630 F. 'EAAIO,, 1s <br /> 0 <br /> s it <br /> EMERGENCY/FIRE NUMBER ROAD NAME Ems Or <br /> LEGAL DESCRIPTION(see tax receipt) <br /> TYPE OF PERMIT(S):DWELLING/BUILDINGGARAGE/ACCESSORY STRUCTUREADDITION e <br /> IT <br /> 9: <br /> 5. C <br /> SANITARY PRIVY FILLING/GRADIN/G �I CAMPING UN/.IST SUBDIVISION <br /> STRUCTURE/ADDITION USE:�aad. 14 i X')V/ g <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) 'z 1 <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T tA! <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T o Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m S <br /> NORTH(N). a n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <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- o <br /> INGS,ROADS,LAKE,LOT LINES. :E <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 I <br /> MUST BE SIGNED AND DATED BY THE OWNER. c W <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE O <br /> ISSUED. g ° W <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT '` ` C) <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 /> 6. � � <br /> .� CIL <br /> 7. <br /> Z : <br /> o1CA E <br /> I declare that this application (including any accompanying schedule)has boon examined by me and to the best of my <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of W'• ` E C <br /> all Information contained in this application(including any accompanying schedule)and I further declare that 1 recognize <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Is- ? p <br /> sus a PemNL 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. I agree to <br /> g permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described promises at any reasonable time for the purpose of Inspection. T E <br /> g i E <br /> SIGN HERE _ r► <br /> (s ro or or bu Ing contractor) (date) <br /> ZONING ADMINISTRATOR <br /> NN• NNN <br /> TOWNSHIP PERMITS MAYBE REQUIRED 18 8 8 8 8 <br />