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WI 64872 Office of Zoning Administrator V'-0 <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, 9 !R O O <br /> APPLICATION FOR LAND USE PERMITS 3 SU <br /> OWNER TELEPHONE �16� c (DQ <br /> m <br /> p O <br /> HOME ADDRESS <br /> r � <br /> 0 <br /> EMERGENCY/FIRE NUMBERROAD NAME ~ <br /> ` � fie. ('_//, �',y/l�1� l�-{� , Cn <br /> Cn <br /> LEGAL DESCRIPTION(see tax receipt) 6.�-V Sec. / / Tf/O tel/ <br /> Q <br /> �p Cn <br /> RAGE/A <br /> TYPE OF PERMIT(S):DWELLING/BUILDING AESSORY STRUCTURE DDITION n •, <br /> S. <br /> Em <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> Cn <br /> STRUCTURE/ADDITION USE: r- <br /> (Hom abin; Commercial Business;Bedroom;Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 w <br /> DIRECTIONS FOR PLOT PLAN DRAWING' (AERIAL OR TOP VIEW) 0 c <br /> CD <br /> '—I o z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m W' .o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C C) <br /> NORTH(N). N ° <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 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. <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. m ° <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BEq ° <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o ' <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ` I <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. y <br /> A � C�W m <br /> m �. m � Qga <br /> 6. : A C 0' y 0"N Z <br /> m O �1O <br /> Z H i <br /> 7. — o'i m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ZS 2C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of CL <br /> 0 <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m : m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m D <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 m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> CD <br /> O m <br /> Q•�/ to : E <br /> SIGN HERE <br /> gnature of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR j+m Fi I .Q() `0 <br /> fA N4 fA fA dim <br /> INT (NJ1 O N NOM <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 Co c no c°o 00 <br />