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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 6) <br /> APPLICATION FOR LAND USE PERMITS s. 4 <br /> r <br /> m o <br /> 1) <br /> OWNER _T TELEPHONE <br /> o <br /> m <br /> HOME ADDRESS 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME \ <br /> LEGAL DESCRIPTION(see tax receipt) E— N� I / —(��/(� <br /> a <br /> Cl) <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> a <br /> 5: <br /> LA. <br /> SANITARY PRIVY--,X— CAMPING UNIT SUBDIVISION 0 <br /> m <br /> STRUCTURE/ADDITION USE: pf ) <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR R <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m T <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m S ;b <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). C v 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO M 3 <br /> 13 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER. o <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. :E <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. �Q <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. o <br /> O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE <br /> ISSUED. g <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z r. <br /> 0 <br /> CONDITIONS OF PERMIT: � <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ^' <br /> ISSUANCE. 1 <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 /> m m v Lv 9 <br /> 6. 3n 4�9 ; <br /> gt <br /> CA C a o o c <br /> 7. Z : w we 'CP =io <br /> m <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of ? a i C <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize e m m <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- v <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 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. T <br /> : <br /> m : <br /> SIGN <br /> (signature <br /> -off owner or building <br /> contractor) (date) <br /> ZONING ADMINISTRATOR <br /> NNtANNN� <br /> N NU�NNNN <br /> P p10 P 00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />