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Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator a o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> 0 <br /> c Q <br /> OWNER <br /> Ole/ S. V, Alan 5QyL TELEPHONE T 6 a7�6 0 <br /> m <br /> � � O <br /> HOME ADDRESS a !3 3 St, ltd '/y <br /> 0 <br /> o <br /> EMERGENCY/FIRE NUMBER ROADNAME <br /> o <br /> LEGAL DESCRIPTION(see tax receipt) S 37 — r�— E r —rs <br /> y � <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY GARAGE/ACCESSORY STRUCTUREADDITI oii <br /> a <br /> w' <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SIS DIVIISION 0 1 <br /> STRUCTURE/ADDITION USE: Cd P1. Gat ct e ��� �� U eeze'ilia O <br /> ome/Cabin; Commercial Business; Bedroom; Deck;etc.) g 5 71 <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR Aji�J((��nj�( <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p (,v <br /> A in <br /> DIRECTIONS FOR PLOT PLAN DRAWING' (AERIAL OR TOP VIEW) <br /> n ii <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, 07� o <br /> STREAM OR RIVER. <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. Q <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE Cr <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: A i <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT n� <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. G <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. y <br /> m m d O <br /> Q W T <br /> 6. c�n '" c ' 3 <br /> Z :: 0 <br /> 7. <br /> M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ZS c E p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of a c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize IS m : m <br /> that this information I am providing will be relied upon by the County of Bumett 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 Cw 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 /> m : <br /> m <br /> //j► E <br /> SIGN HERE 060r t? a� <br /> (sig e o ne ontractor) (date) <br /> ZONING ADMINISTRATOR ' <br /> �nwwww`� <br /> ON frlNNfn V1 <br /> N N ON NOO <br /> OO O O O O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED �0 0 0 0 0 0 0 <br />