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e* 471 y`.1 <br /> Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator v G) Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> 0 <br /> OWNERC) r/5 TELEPHONE �I _I1/S _ 1/ O f <br /> HOMEADDRESS 3 1j Cr0.AT /. ' S a <br /> r m <br /> EMERGENCY/FIRE NUMBER g C� ' ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) I I QSM <br /> N <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION Cl) ' <br /> Cr C <br /> 5 <br /> R <br /> S. <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o' <br /> J � <br /> STRUCTURE/ADDITION USE: Yj L, / <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) 1 T <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR0 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. n 3. C (0� <br /> O N ~ lO <br /> DIRECTIONS FOR PLOT PLAN DAWING. (AERIAL OR TOP VIEW) <br /> T th <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T o Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). c <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m Ul 3 <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, <br /> STREAM OR RIVER. Z <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILD- o <br /> INGS, ROADS, LAKE, LOT LINES. 1. <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 t <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> m o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 0 <br /> ISSUED. Cr ° W <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z C> <br /> CONDITIONS OF PERMIT: o <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 /> 5. PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 6. M - mr Cg3 <br /> ,� 9a NCL <br /> 7. o <br /> i `o i i <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my G <br /> 4 : <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of 6, <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize C m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- ' i GZ i i v <br /> sue a permit. 1 further accept all liability which may be a result of the County of Burnett relying on this Information 1 am u <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other ' o <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. <br /> m i <br /> SIGN HEREJ' 00i <br /> g ture of oyffle r building contractor) --� T <br /> to <br /> (date)ZONING ADMINISTRATOR .Cn O , 00TOWNSHIP PERMITS MAY BE REQUIRED no o 0 <br />