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oy�czynp , <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -St o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 4 <br /> w <br /> N <br /> OWNER ►_JC.J' 1 TELEPHONE C <br /> HOME ADDRESS-1I9 S, \J1Jr11�1 La6rc3oit •�Z--- l�o�Js <br /> � r m <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LOTS <br /> �,`' r <br /> LEGAL DESCRIPTION(see tax receipt) U' f--4�� �T� �� &e' <br /> 9y 0 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION a —� <br /> a n, <br /> H KJ <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> y <br /> �/ 1 (0 <br /> �Sm Pe ()-7— 6% �J <br /> STRUCTURE/ADDITION USE: a fif � <br /> (Home/Cabin; Commercial Business;Bedroom;Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR In 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> 0 rA <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m jo <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C O <br /> NORTH(N). y 3 <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, Z <br /> STREAM OR RIVER. p <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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N I <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> v � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE q <br /> ISSUED. <br /> �1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o I <br /> CONDITIONS OF PERMIT: yF� x/ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT � (I <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. <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 /> Cvc>r oeov <br /> Co3. m � ma m <br /> Sit <br /> 7. o : m '� <br /> =y: m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my E Si E E ? C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of n <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- O <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information 1 am <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 /> m : <br /> M :: <br /> SIGN HERE <br /> (signature of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR \ 1 1 dYlICXI l d+ <br /> N NEnNN (T:Cn <br /> N fJ10 UI ut 00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />