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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator -V o 0 <br /> APPLICATION FOR LAND USE PERMITS <br /> a <br /> OWNER I I rn o t k y A. S k u-n e.5 TELEPHONE A1301 o 4- <br /> HOME ADDRESS <br /> to a Uvla►, L'ewr t VY1CL ftteOf i'Vjn1 SJ i IS o <br /> EMERGENCY/FIRE NUMBER g 0 6 S ROAD NAME So. Td h O se.j LA Ke 1?oA d 1 0 e <br /> LEGAL DESCRIPTION(see tax receipt) <br /> G7 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE�ADDITION in <br /> c <br /> c <br /> CIL <br /> S. so <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> L m <br /> STRUCTURE/ADDITION USE: P C K <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. O <br /> DIRECTIONS FOR PLOT PLAN D AWIN 7 (AERIAL OR TOP VIEW) a <br /> O m <br /> ELT OT <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m or c <br /> NORTH(N). <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, <br /> STREAM OR RIVER. Z <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. to <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE a 0 <br /> ISSUED. Cr <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT � <br /> ISSUANCE. i <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 /> 6. <br /> 3 ' 'rE m <br /> co w ii 3 <br /> 7. <br /> knowledge and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and o w � oma <br /> -y: .D <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ? A <br /> E <br /> m <br /> accuracy of <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Is- <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 <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. <br /> SIGN HERE <br /> re of owner Wing contractor) (date) <br /> ZONING ADMINISTRATOR J III{ <br /> i i i i E <br /> j MNNN <br /> N N fRLn <br /> N A N N N(T Ln <br /> N U ONtlIOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED `1 0 0 o ii o 0 0 <br />