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C)�1 cww, <br /> Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 o z <br /> APPLICATION FOR LAND USE PERMITS . 4 <br /> r <br /> e <br /> OWNER go !/1l7 .kj Jr 0 1-7 �/ TELEPHONE L f <br /> HOME ADDRESS /V 1r/3 Z t Ke I/ hi 'e &'ar mpi ro 9 <br /> -r m <br /> EMERGENCY/FIRE NUMBER M ,— ROAD NAME/,,4 f e r 5 /2 C P0 <br /> LEGAL DESCRIPTION see tax receipt) I m 2 } <br /> Q <br /> N o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTUREADDITION C ' <br /> Q <br /> 5. <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT '4= o'SUBDIVISION <br /> STRUCTURE/ADDITION USE: �— <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) a <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR 9i <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p 3 W <br /> 11 w <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m S , jp <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). N 3 <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, 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- t <br /> INGS,ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. ri <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. m' o <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE q ° r' <br /> ISSUED. 2 y <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c O <br /> CONDITIONS OF PERMIT: <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. 11 1 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY 1G� <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 opo 0 <br /> 6. MM <br /> s � osi_ <br /> 7. of CD mi <br /> 1 declare that this application (Including any accompanying schedule) has been examined by me and to the best of my InIn <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofo E ; ' S <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m � i <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- ; y 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 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 reasonable time for the purpose of Inspection. m <br /> SIGN HERE {�r: - <br /> gna roof owner ilding contractor) / '% (dad ) <br /> ZONING ADMINISTRATOR rWT ' i '6' <br /> - I UI O ,fN7, NOO <br /> TOWNSHIP PERMITS MAY BE REQUIRE 0 o 0 0 <br /> _ _ J <br />