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Comp / <br /> Burnett County 7410 Co. Rd. K, No.102,Siren,WI 54872 Office of Zoning Administrator - o° o <br /> litAPPLICATION FOR LAND USE PERMITS 3. <br /> .. r <br /> ' w <br /> ,{ Cj <br /> OWNER i �/yr _ � /I/I � � TELEPHONE f,S g/ao 6- (✓/ (�� m <br /> HOME ADDRESS p�f�f Y P ` e T'^ gy k/ <br /> r � <br /> EMERGENCY/FIRE NUMBER ROAD NAME �,(�(��n sa n 1 0 <br /> LEGAL DESCRIPTION(see tax receipt) 00 o <br /> C) � <br /> N <br /> 0 <br /> TYPE OF PERM : DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION a <br /> m' Y/ <br /> SANITARY lmmmwPRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 tjl.J) <br /> y <br /> MSTRUCTURE/ADDITION USE: �� � �- <br /> fl <br /> (Home/ bin;Commercial Business; Bedroom;Deck;etc.) 'U <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR3, n <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 41 <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) C <br /> O B. <br /> ''—' o Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 'A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> NORTH(N). fn <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <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. --y <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N T <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. i'c <br /> V9 SU <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE a 0 <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <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. p <br /> 3 <br /> Z : `^ M,o^< 0,p <br /> M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G� ? C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of W a g <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- y O <br /> sue a permit. 1 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 permit county officials charged with administering county ordinances or other i m <br /> authorized person to havwscees a above described premises at any reasorpebWjiMe for the purpose of inspection. -n . <br /> SIGN H <br /> ( n u o ner �ntracto (d <br /> Afe) <br /> se <br /> ZONING ADMINISTRATOR <br /> ILI <br /> (.N71 (, <br /> RED N71 .fNrl N O <br /> TOWNSHIP PERMITS MAY BE REQ I _�"'— — ' I o 0 0 0 0 <br />