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Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Adminisl Z <br /> APPLICATION FOR LAND USE PERM TS 3. <br /> w G �. <br /> 714 Woods - <br /> /7i :) D, m6 <br /> OWNER D��/ f.. �,� TELEPHONE <br /> M / m <br /> HOME ADDRESS g OQ f'7 0 [SO/V PJ F Wel,+, WLs Sy 9y3 0 <br /> EMERGENCY/FIRE NUMBER 8 �5 / ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) �IFyi (a <br /> 11� <br /> N <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION c <br /> n <br /> m <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> nn �% S/ m o <br /> STRUCTURE/ADDITION USE: �/ � fo �V�- or <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) a <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR T 3 W <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) Om a <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 C n <br /> NORTH(N). y 3 <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. <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. 1.1 <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. ,o c <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE Cr <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o 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. _'5' 6 - a til CO,..�f Luca o o✓ 5th 1P14.A /p8�r►t�� �Pr° � ;av ��5D� qo � o m <br /> m �. m � iO3FL <br /> 6— ��� 9 nN �NFC_ �l <br /> 7. <br /> _v,: m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my d E c p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of i <br /> CL C <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 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 hilve acces_sto the above described premises at any reasonable time for the purpose of inspection. m <br /> m : <br /> m <br /> SIGN HERE <br /> lure of ownbuilding contractor) (date) <br /> ,prO <br /> ZONING ADMINISTRATOR r 46 <br /> 1 ,vi .uNi o 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />