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v/�),, " ! l <br /> Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator � o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> w o C> <br /> I <br /> OWNER (7 � ��TELEPHONE <br /> HOME ADDRESS 0"/- SAI M N S /a / <br /> EMERGENCY/FIRE NUMBER Aqq IROAD NAME <br /> L GAL DESC4T10N(sem receipt) Atc&eS Y04I/ R y <br /> e <br /> V) G <br /> TYPE OF PERMIT(S):DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION_ Cr ' <br /> CL <br /> 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> N U) <br /> R <br /> STRUCTURE/ADDITION USE: rP_ n <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. In <br /> In <br /> x <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) p 2 <br /> T Z <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 r_ IF <br /> n <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER. I 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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <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. m c <br /> OQ o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 5 <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: u <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 /> PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. <br /> zvor a o� om <br /> I gg <br /> 6• �` 0 jFQ 70 <br /> v 0, 0 (0S7. � <br /> o .� <br /> M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G3 c p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofCL <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m : ` M <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m ': 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. 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 ins e m <br /> SIGN HERE <br /> (s oT owner or b Ing contractor) „-j (date) <br /> I <br /> ZONING ADMINISTRATOR I " 4 � '1 h <br /> �! iW 40 fa fa 40 <br /> niro��oo <br /> TOWNSHIP PERMITS MAY BE REQUIRED V 0 0 0 0 0 0 0 <br />