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6l 07- ' <br /> Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator ' o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 4 <br /> y 0 <br /> OWNER `-` TELEPHONE ?�t` <br /> �j�� m <br /> HOME ADDRESS a l� / �� *tea ���� v 0 <br /> 0 m <br /> EMERGENCY/FIRE NUMBER 2Q /!Z 7 ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) ti <br /> TYPE OF PERMIT(S):DWELLING/BUILDING X GARAGE/ACCESSORY STRUCTURE ADDITION c <br /> n <br /> 5. <br /> N_ <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> rn U I <br /> STRUCTURE/ADDITION USE: // 9 <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) 'o a <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR 3 ( 1I <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m lJ <br /> 0 a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T <br /> ?� Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. MS ,p <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). y o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m 'q 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER. <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILD- (, 1 <br /> INGS,ROADS,LAKE,LOT LINES. V/ <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. i <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS S <br /> MUST BE SIGNED AND DATED BY THE OWNER. to o <br /> O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BEa 0 ()J <br /> ISSUED. 2 <br /> I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> 0 <br /> CONDITIONS OF PERMIT: / 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT IN <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 }C <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 ' 3 'nt��t71, <br /> m <br /> 6. td � 9 am a- 'O <br /> o : C 0 0 a <br /> mCr i i m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ? 10 <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of a g : , <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize 6` m m : m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m 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 m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. -n <br /> o : <br /> SIGN HERE <br /> (signature of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR Im T I rrl Lf <br /> N K)Nsewww�+ <br /> U N K)CA ut <br /> ut N Out NOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 <br />