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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator vel <br /> APPLICATION FOR LAND USE PERMITS . <br /> ^' r <br /> N O^ <br /> OWNER h 1\ F r Li.E TELEPHONE $ <br /> O <br /> HOME ADDRESS yb O <br /> ci Lf L <br /> EMERGENCY/FIRE NUMBER 3 90 3 ROAD NAME q rry L q rl` o <br /> LEGAL DESCRIPTION(see tax receipt) o e t <br /> TYPE OF PERMIT(S):DWELLING/BUILDINGGARAGE/ACCESSORY STRUCTURE ADDITIONc <br /> 4: <br /> 5. <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0' <br /> r <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Comme cial Business;Bedroom;Deck;etc.) Zv -q <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> DIRECTIONS FOR PI OT PLAN DRAWING- (AERIAL OR TOP VIEW) C � <br /> T <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. G Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m i <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO M 3 <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, 1 a <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- <br /> INGS, ROADS, LAKE, LOT LINES. W <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. Lv <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 'S <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE w <br /> ISSUED. 2 S <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z �o <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. l�J <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 /> 6. 3 & INIMM <br /> a <br /> 7. 9 ' IRCo "' 0m3 <br /> N <br /> _ i A <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my i p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of '• m' E `E C <br /> all information contained In this application(Including any accompanying schedule)and I further declare that I recognize m m m <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- A, p <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 other <br /> re ? m ; <br /> authorized person to have access to the above described premises at any asonable time for the purpose of inspection. <br /> ry-n i <br /> SIGN HERE <br /> c, <br /> (signature of or or building contractor) (data) <br /> ZONING ADMINISTRATOR VIfYI�I(/i� Lill <br /> A <br /> b9N NNM I" <br /> P0pNin100 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 c:0 0 0 0 0 <br />