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Office of Zoning Administrator Z <br /> n 7410 Co. Rd.K, No. 102,Siren,WI 54872 9 o 0 <br /> Burnett County 3. ,. <br /> APPLICATION FOR LAND USE PERMITS r <br /> . <br /> OWNER TELEPHONE)/S-�fo <br /> n .. O <br /> HOME ADDRESS Sy � d V 1 1° (j ) ' 4 �I r �^ <br /> EMERGENCY/FIRE NUMBER L ROAD NAME '— <br /> LEGAL DESCRIPTION(see tax receipt) I(A) d�re S, o <br /> N 0 <br /> Q <br /> TYPE OF PERMIT(S):DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION <br /> o. <br /> N I \ i <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION N <br /> � V 1 <br /> � n lel <br /> STRUCTURE/ADDITION USE: 11�, <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> G 3 l <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR ^ <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> DIRECTIONS FOR PLOT P ALLN DRAWING (AERIAL OR TOP VIEW) Z <br /> In v <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. mIr <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> NORTH(N). m 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, I c <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. AND SHOW AREAS TO BE GRADED OR FILLED. <br /> ii <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS c <br /> MUST BE SIGNED AND DATED BY THE OWNER. o ri , <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE V 1 <br /> ISSUED. Z 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: ( I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT �j <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. p -0 0 r qoq o m <br /> 5. m 2. ek % <br /> K a n <br /> 6. 0 : <br /> -coi i i m <br /> 7. ZS a C) <br /> I declare that this application (including any accompanying schedule) has been examined or me and it 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 m a <br /> all information contained in this application(Including any accompanying schedule)and 1 further declare that 1 recognize i i `. o <br /> that this information I am providing will be relied upon by the County of Bumett 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 I am m <br /> providing in this application. 1 agree to permit county officials charged with administering county ordinancgor o <br /> authorized person to have access to the above described premises at any reasonable ti <br /> SIGN HERE (d <br /> (sl a of ow or or b d g conVactor) _ I. <br /> InkH <br /> MN an wh <br /> ZONING ADMINISTRATOR n <br /> g / N N N N N Vt <br /> l 5 � 00000 <br /> _._ v Co0 <br /> 0000 <br /> 0 <br /> 'l 0000000 <br /> TOWNSHIP.4P,,E'R)M'IITS MAY BE REQUIRED <br /> f00 C�(AS2 Q)rWi• ' OWner k `C ^ r T-6 Id Yo lnduC_ <br /> a*>N' /0 4>f 8 Acf 4 B rt �-k- <br />