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Burnett County 7410 Co. Rd.K, No. 102,Siren,W154872 Office of Zoning Administrator v o <br /> APPLICATION FOR LAND USE PERMITS <br /> N 0 _\) <br /> OWNER-j Ij,W TELEPHONE 0 <br /> m <br /> HOME ADDRESS O <br /> � Z V) 1w1c�b .1 e V:K1l1CAn) � I ' C ! 0 0 <br /> � �� <br /> EMERGENCY/FIRE NUMBER .A II II ''W11 A ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) PCI, I I Ll Q—rs \ <br /> t'n <br /> sV) _ <br /> TYPE OF PERMIT(S) DWELLING/BUILDING Z GARAGE/ACCESSORY STRUCTURE ADDITION a <br /> S. <br /> SANITARY—PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> rn <br /> STRUCTURE/ADDITION USE: 14 s w,'!i_ <br /> •c <br /> (Home/Cabin;Commercial Business; Bedro m;Deck;etc.) 'a <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR ,i 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> w <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 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> NORTH(N). ff! ° <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m —y v <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, (J I o <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. <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. m' <br /> o $ <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE Cr °77 <br /> ISSUED. = �/I r <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: S <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. 00 <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 SPECIFICALL P RMITTED. <br /> 5. 2­31 <br /> 9D 6. 9 . <br /> ✓// cow <br /> Z : Amo : m <br /> 7. P m <br /> E m <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my ; ZS g E C <br /> knowledge and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of a <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m <br /> Is 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. 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 i E <br /> authorized person to have access to the above described premises at any reasonab `oi#e,o6T--cff0 m <br /> SIGN HER t3 <br /> ignature of owner or building contractor) <br /> SEP <br /> ZONING ADMINISTRATOR k <br /> P O N 91TOWNSHIP PERMITS MAY BE REQUIR .___� 0____ 0 0 0 0 <br />