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Burnett County 7410 Cy Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator -0 G) o <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> N � <br /> N <br /> C <br /> OWNER TELEPHONE m <br /> HOME ADDRESS'.1Q y t`�OY.�f t Qc'Z.SF Y✓t 6k7 1' M'i O <br /> r CD <br /> GN 0 <br /> EMERGENCY/FIRE NUMBER SIG,4 SDo 1T4 c� �(�� ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) ) m <br /> y o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION c <br /> CL <br /> S.N <br /> SANITARY PRIVY FILL\IN�GIGRADING CAMPING UNIT SUBDIVISION 0 <br /> t\ <br /> STRUCTURE/ADDITION USE:�`ZL <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) � <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n = 0 <br /> A io <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n 2) <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS (NB)AND INDICATE m <br /> NORTH(N). o <br /> 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, Z <br /> STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. o <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. Nr <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC., THE PLANS 8. <br /> MUST BE SIGNED AND DATED BY THE OWNER. 1 OFF 1 <br /> O 9 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 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. l <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, d <br /> PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. <br /> m(1 � 3 a m x x <br /> 6. iF : W C N N O J 3 <br /> @ N O O O q <br /> 7. o <br /> 1 U, m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G7 c p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of o C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize 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- C) <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. T <br /> M : <br /> / m <br /> SIGN HERE 1" '�tM4�,,� gyp"-" )q -o/ <br /> ignaIt of owner or bull ng contractor) (date) <br /> ZONING ADMINISTRATOR v ! GL n . . . w <br /> 40�A4A404AfA- <br /> N N OI N N V t N <br /> (T Ol O UA MOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED ✓/ /` o 0 0 o a o 0 <br /> 0 (� T16 <br />