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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator Com-C 0"" ✓ .o <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> OWNER ! ; TELEPHONE J <br /> Ioa.IS-3 et .)Plyrrlo7.;kA, m 5:/ Q <br /> HOME ADDRESS <br /> p <br /> v r � <br /> 0 <br /> EMERGENCY/FIRE NUMBER < ROAD NAME ,JJ 4) <br /> f <br /> LEGAL DESCRIPTION(see tax receipt) ' _ rn —� <br /> Q <br /> TYPE OF PERMIT(S): DWELLINGIBUILDING GARAGE/ACCESSORY STRUCTURE__k(__ADDITION Cr <br /> Q: <br /> S. <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> STRUCTURE/ADDITION USE: � V ' <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR T <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> M <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0n a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 'o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE MIF <br /> n <br /> NORTH(N). In r <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m 3 <br /> ' 3 <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. lu <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 1 <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. too c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BECr <br /> ISSUED. 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o -t,-) <br /> CONDITIONS OF PERMIT: <br /> ( <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 /> A -0mr vL <br /> 6. 9 � 4al% <br /> ItwoE <br /> 7. w8Q : � <br /> =w € m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c ` C <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 aCD E E m <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m'. `. 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 m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. -n <br /> CD <br /> SIGN HERE . / ; <br /> (siggnnature of owner or building contractor) (date) �} <br /> ZONING ADMINISTRATOR v''� (G r I' <br /> H6eNNCA <br /> N V1"N VIN <br /> UI G V1 V1 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />