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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator a o <br /> APPLICATION FOR LAND USE PERMITS 3 4 <br /> - r <br /> U /�� 9j 4r Z-3S-5 = .. <br /> OWNEf'2 l� c C'14��/N�fL(� TELEPHONE <br /> DO <br /> v <br /> m <br /> HOME ADDRESS 0;1A1 57 <br /> 2,7 <br /> EMERGENCY/FIRE NUMBER 7� ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) 2 _ 3 „ 7 o c) . <br /> y <br /> TYPE OF PERMIT(S):DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE >S, ADDITION <br /> a <br /> 5. <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> N <br /> STRUCTURE/ADDITION USE:— $Yz�)2/4 Pols pi c�K()I N h 46'YLje� wA <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 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> a <br /> DIRECTIONS FOR PLOT PL6N DRAWING,• (AERIAL OR TOP VIEW) p c <br /> n B <br /> o Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 ;b <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m ar <br /> NORTH(N). C O <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, 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. <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. c <br /> v $ <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BEq 0 <br /> ISSUED. o <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z <br /> CONDITIONS OF PERMIT: P <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 /> �U�eiQivSl � vt�r O � <br /> 6. m �. m � O�I Q m <br /> el 1, / CK <br /> 7. Z : m Wq i 9 1 <br /> o li .'a <br /> y: 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 com P 9 P late. I acknowledge that I am responsible for the detail and accuracy of m C <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- p <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this Information 1 am 03m <br /> providing in this application. 1 agree to permit county officials charged with adrr)MFste [1g county ordinances or,o�her ` m <br /> authorized person to h ass to the above scribed premises at any reasons dime for the purpose of insp 4tion. <br /> m : <br /> SIGN HERE <br /> ( na re of own r Ildi c actor) ; I -s� �� <br /> ZONING ADMINISTRATOR <br /> wwfxwww <br /> N N N N M <br /> L�' <br /> NOfr fn 00 <br /> TOWNSHIP PERMITS MAY BE REQUIR '-" 0 0 0 0 0 0 0 <br />