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',!V c[)Y, <br /> Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator - o <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> ir 0 <br /> OWNER TELEPHONE <br /> O <br /> HOME ADDRESS D *'Ao = 9 <br /> EMERGENCY/FIRE NUMBER ROAD NAME (Qi \� <br /> LEGAL DESCRIPTION(see tax receipt) i "f o �n <br /> to � V ' <br /> c <br /> TYPE OF PERMIT(S):DWELLING/BUILDING ARAG CCESSORY STRUCTUREADDITION 5 <br /> w <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION N <br /> STRUCTURE/ADDITION USE: � <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) 9t <br /> Vl <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR C 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 50 CO <br /> DIRECTIONS FOR PLOT PLAN DRAWING' (AERIAL OR TOP VIEW) A Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE N _ 3 <br /> NORTH(N). m 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, ({ oZ <br /> STREAM RIVER. <br /> 4. SHOW THEE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILD- <br /> 11-1 <br /> INGS,ROADS,LAKE,LOT LINES. AND SHOW AREAS — rpi W <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED , BUILDER,CONTRACTOR, ETC.,THE PLANS <br /> BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, B �� c <br /> MUST BE SIGNED AND DATED BY THE OWNER. p <br /> _� rh <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE v 1 <br /> ISSUED. 1 <br /> Z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. P ` <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. <br /> 2.3. NO REMOVAL OR <br /> OR SHING OF TREES AND ORELAND ALTERATIONS ARE ALLOWEDIS TRICTED ALONG LINE. <br /> UNLESS SPECIFICALLY <br /> F CALLLY <br /> PERMITTED. C5 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN 75 FEET OF THE OHWM OF LAKE , <br /> PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> CIO <br /> 5. '� e3 ' rn <br /> a � _ <br /> ti � Cww7� .= <br /> w <br /> 6. Z : w �1� `• 70 <br /> 7. _ur: . 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 m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m O <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> �i <br /> ' 1 'm <br /> sue a permit. 1 further accept all liability which may be a result of the County of Burnett relying on this information I am <br /> providing in s application. I agree to it county officials charged with administering county ordinances or other <br /> authorized ers to have access t e above scribed premises at any reasonable time for the purpose of inspection. , <br /> SIGN HERE (date X7 <br /> (s re of owner or building contractor) <br /> w • w <br /> ZONING ADMINISTRATOR ' I H 401"H w H <br /> N NCnNNC"N <br /> fT Vt O V•Vt O O <br /> .--- 0 0 0 0 0 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />