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Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator -0 G) z f� <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> y O <br /> N <br /> C <br /> � d <br /> OWNER / � TELEPHONE 7Z� j 7 m <br /> HOME ADDRESS <br /> EMERGENCY/FIRE NUMBER ROAD NAME ` ~ <br /> LEGAL DESCRIPTION(see tax receipt) f GAA f /z> m <br /> /iYT //✓ C7u7�Eo� f C,l/N jf/O 3O Dv o <br /> V7 � <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION Cr <br /> a <br /> H <br /> SANITARY PRIVY �D FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> W'14 <br /> KN <br /> STRUCTURE/ADDITION USE: i .ten /n z"�!a&4 77L21 <br /> ome/Cabirc ommercial Business; Bedroom; Deck;etc.) aCD <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR 3 v 1 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> Cz <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m �? <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 /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, z <br /> STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILD- \ n <br /> INGS, ROADS, LAKE, LOT LINES. vJ <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 <) �. I <br /> MUST BE SIGNED AND DATED BY THE OWNER. ^ o <br /> q <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BECr ° f . <br /> ISSUED. 2 W <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. P <br /> CONDITIONS OF PERMIT: c Q <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. Num Sar oar &j-t-ro rI•�,a_c+�'�_.�nG jyJ/QX o`Z �/ GI F ``; <br /> `6. � ✓✓✓V m . dC mago <br /> m <br /> z COD <br /> fill A \` <br /> m <br /> I declare that this application (including any accompanying schedule) has been exam by m nd to the b Lj c E A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am respons' r the detail, cy of SU c Et c <br /> all information contained in this application(including any accompanying schedule)an urtj�► 1 `tkq[j ognize �6: �" � m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin m ermilo her to is- �: 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. 1 agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to the above described remises at an reasonable time for the purpose of inspection. <br /> ` <br /> P P Y P P P m : <br /> co <br /> CD : <br /> SIGN HERE <br /> 72 (sl t of ne or u ding contractor) ( ate) <br /> ZONING ADMINISTRATOR <br /> �ON N (11 N N(T CII <br /> (T NON (n0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> 00000 0 <br />