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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 <br /> Office of Zoning Administrator L� Z` <br /> APPLICATION FOR LAND USE PERMITS T <br /> OWNER <br /> E TELEPHONE <br /> HOME ADDRESS u�` td/• g <br /> ► �c�B G � <br /> EMERGENCY/FIRE NUM13ER0-5?49 ROAD NAME L.XLt <br /> LEGAL DESCRIPTION(see tax receipt) S1lp /?ft'tJ' �3f<, '1111 <br /> r GS d.3 AJ &q NSW I <br /> A) <br /> TYPE OF PERMIT(S):DWELLING/BUILDING T <br /> RAGE <br /> GO <br /> GACCESSORY STRUCTURE V ADDITION e <br /> cr <br /> CL <br /> SANITARY PRIW S. <br /> FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> ^ rn <br /> STRUCTURE/ADDITION USE: Er L6 <br /> r U m <br /> (Home/Cabin;Commercial Business; Bedroom; ck;etc.) <br /> 1 <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. r .� <br /> DIRECTIONS FOR PLOT PLAN QRAWI r- (AERIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T )) <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m a Y' <br /> NORTH(N). C " <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO In 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, i 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. <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. <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 0 <br /> ISSUED, 5 o <br /> n <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. '. <br /> _CONDITIONS OF P RMIT: c <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 /> 5. PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 6. � 3 n3F� m <br /> a <br /> v avo <br /> 7. vi amo : <br /> P : <br /> 1 <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my N <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am resaccuracy i : m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize mm m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- G� <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 ac ess to the above described premises at any reasonable time for the purpose of Inspection. m <br /> m <br /> - <br /> SIGN HERE <br /> w i <br /> (signature of owner or building contractor) (d te) <br /> ZONING ADMINISTRATOR V j m Flan I ar_n 1 <br /> fA H40 H/A 4W�+ <br /> N tll NN(n(n <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 v,0 0 <br /> 000000 <br /> 000000 <br />