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BuMett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator o a <br /> - <br /> APPLICATION FOR LAND USE PERMITS 3 < <br /> w <br /> w <br /> c <br /> OWNER TELEPHON <br /> SC t-�Ma)f �UA� y37 - 43)3 e <br /> x <br /> HOME ADDRESS 13y , )i-ACKStJN _122WC jksnm[-::.5 MSI <br /> o <br /> EMERGENCY/FIRE NUMBER 4!r Ro 01 i P6­ ROAD NAME ©wat RD <br /> LEGAL DESCRIPTION(see tax receipt) — <br /> i <br /> a <br /> y o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION cr <br /> C <br /> n <br /> 5. <br /> LA <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> Cn <br /> STRUCTURE/ADDITION USE: ' ` fir <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 'q <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C .r n <br /> NORTH(N). y o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <br /> v <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER. P <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. r ' <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N W <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 � t <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 5 <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c CIOr <br /> CONDITIONS OF PERMIT: W <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ) <br /> ISSUANCE. O <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY r <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 /> z -0mr vvm <br /> o <br /> 6. o''" wo � 3 <br /> y : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 10 <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of n <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m <br /> M <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m 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 E E <br /> providing In this application. I agree to permit county officials charged with administering county ordinances or other s E <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. .n <br /> w : <br /> SIGN HERE <br /> (si of ow r or Ing con ctor) date) <br /> ZONING ADMINISTRATOR ' <br /> NHNWdIH� <br /> N N�TNNfl1 V1 <br /> V7 Vt O Vt Vt O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 00 0 0 0 0 0 <br /> 0000000 <br />