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C)A Cvrn� I <br /> Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator -0 O Z <br /> APPLICATION FOR LAND USE PERMITS 3 4 <br /> r <br /> p( O <br /> C <br /> OWNER .+ n r A / L TELEPHONEit e, 03 <br /> Q- '^ f� O <br /> HOME ADDRESS <br /> O 1 <br /> EMERGENCY/FIRE NUMBER a ���� ROAD NAME A^ 0r ~ <br /> LEGAL DESCRIPTION(see tax receipt) � rn�o-� <br /> N 0 <br /> TYPE OF PERMIT(S):DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION c �• <br /> a <br /> S. <br /> E. <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION c <br /> m ' lJ <br /> STRUCTURE/ADDITION USE: Gffifir <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) M <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. ^' <br /> w <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T <br /> ?� Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 'o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE rn n <br /> NORTH(N). rA 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDINGS)TO ALL LOT LINES, (B)BUILDING(S)TO rn v <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER. <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' c <br /> o 9 41 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 5 SU <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: <br /> e l <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 1 <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 /> ;0 '11 m r- <br /> 6. <br /> 6. .� � � A <br /> v : Cin '" 0 53 <br /> 7. o <br /> M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Z5 c C <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m <br /> ate : i <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize 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 <br /> providing In this application. 1 agree to permit county officials charged with administering county ordinances or other m i <br /> authorized person to have access tot a above described premises at any reasonable time for the purpose of inspection. <br /> SIGN HERE t__L� <br /> (signature of ner building contractor) (date) <br /> ZONING ADMINISTRATOR . . . . <br /> h NN 40 f d1� <br /> N NUN N(n N <br /> N p O p p O O <br /> 0000000 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> 0000000 <br />