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N Oc" 7 <br /> Burnett County 7410 Co. Rd.K, No.102, Siren,WI 54872 Office of Zoning Administrator � o° a <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> � S <br /> (("f� N O <br /> OWNER � TELEPHONE 6(, 7?t S a <br /> �Fl w CS t <br /> HOME ADDRESS (o 1 Ke— & -10 <br /> EMERGENCY/FIRE NUMBER (0610 ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) <br /> y 0 <br /> TYPE OF PERMIT(S):DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE--V—S--ADDITION Cr <br /> e. <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION In <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 O <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. �p N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m or <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE y a <br /> NORTH(N). <br /> 3 SHOW CENTERL <br /> INE OFONS IN FEET OF THE FOLLOWING: (A)ROAD,(C)BUILD NG(S)MEASUREMENTTO THE(ORDINARY HIGH TO ALL LOT WATER)MARKT OH(WM OF LAKE, m v <br /> Z <br /> 0 <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. <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 m c <br /> MUST BE SIGNED AND DATED BY THE OWNER. o 9 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE <br /> Cr <br /> ISSUED. <br /> Z C� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. ° 1 U <br /> CONDITIONS OF PERMIT: N z <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT3 <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. A 'o mrpR 4O4 Om <br /> 6. 1 i a m o N om 3 <br /> Z : r .0 <br /> 7. =ca m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to 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 ? o ? A <br /> all Information contained in this application(including any accompanying schedule)and I further declare that I recognize m <br /> 6'S m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or oth m <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 /> SIGN HERE Ids) <br /> (signature of owner or building contractor) <br /> ZONING ADMINISTRATOR ` �� ° `A h 40 W u h~ <br /> N (N71 O�ri OO <br /> 0 0 0 0 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />