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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator U-�o <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> y O <br /> c <br /> OWNER TELEPHONE �1 O 3 -)%D 033 8 <br /> o <br /> m <br /> HOME ADDRESS 1b`L<% p�R�3y1.oc�� 5� tom\-�i�U�\��P V 2� � 0 <br /> EMERGENCY/FIRE NUMBER Z�75� (� ROAD NAME � eMQ, pV V9 m <br /> qj � 1 <br /> LEGAL DESCRIPTION(see tax receipt) -�— <br /> � <br /> �/ � N <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/AC SSORY STRUCTURE ADDITION Cr <br /> a <br /> 5. <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o'� <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR 9 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. C ^� <br /> .A el <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O <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 /> NORTH(N). 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, <br /> STREAM OR RIVER. c <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. SU <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. f <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. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BEa 0 <br /> ISSUED. w <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> 0 <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. <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 /> P DS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. riv &Pek-R� /51-vtox n — <br /> s. <br /> � "a �1 ; <br /> 9 <br /> litN <br /> 7. Z : F31'� ` i .'0 <br /> o : <br /> =y: M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my cp <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of v 1-0 <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize 0 m <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m p <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information <br /> providing in this application. 1 agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to the above deqcrAbed premises at any reaso tion. m <br /> r C <br /> U <br /> SIGN HERE23 <br /> ign re of owner or it Ing contractor) ) <br /> i.' <br /> ZONING ADMINISTRATOR ' w <br /> HHH4WH4� <br /> TOWNSHIP PERMITS MAY BE REQ RED 0 0 0 0 0 0 0 <br />