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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -V o„q <br /> _APPLICATION FOR LAND USE PERMITS 3, 4 <br /> OWNERF (//Cil /!// p lTELEPHONE <br /> 656 —7a// v � — <br /> HOME ADDRESS ���1 ��' �nLAOaI�J 0 <br /> q p_ o <br /> EMERGENCY/FIRE NUMBER J ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) f —C \ <br /> . ZY141 <br /> TYPE OF PERMIT(S):DWELLING/BUILDING ARAG CCESSORY STRUCTURE�e'OeADDITION y 0 <br /> c <br /> or <br /> CL <br /> 5. <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> STRUCTURE/ADDITION USE: I� <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) C:5 <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. mO ; <br /> 7u 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING' (AERIAL OR TOP VIEW) m0 0. <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 t7 ^ Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m ar <br /> NORTH(N). C _0 <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- <br /> INGS, ROADS, LAKE,LOT LINES. c{ <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR,ETC.,THE PLANS 3 <br /> MUST BE SIGNED AND DATED BY THE OWNER. 0 c <br /> v ; l <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE a c eISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z o \J) <br /> CONDITIONS OF PERMIT: �s <br /> ' I <br /> tSIVEEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> IUANCE.2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. G} <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. � � a, ? L <br /> fo 3F n <br /> 7. <br /> Now =m3 <br /> Z9 w , 1 <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of Cx t C C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize i mm S M <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- p <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. I agree to permit county officials charged with administering county ordinancesor other10 <br /> authorized person to have access to the above described premises at any reasonable ti for the purpose of jinspection. m <br /> (D ? <br /> SIGN HERE17 <br /> ( g ature of o e r building contractor) <br /> (Ate) ! E <br /> ZONING ADMINISTRATOR <br /> ' 464440«40'A <br /> fN7� M o rii r)0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />