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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872Office of Zoning Administrator 6Jq <br /> , Z� <br /> APPLICATION FOR LAND USE PERMITS ° <br /> ^' r <br /> OWNER�� TELEPHONE a o1 T <br /> HOME ADDRESS `Q `f 'Jo �� "CitL , A-f, //v ���Q a \ 0 <br /> / / o m <br /> EMERGENCY/FIRE NUMBER // ROAD NAMES of dI- � t<Jn< ,C� <br /> LEGAL DESCRIPTION(see tax receipt) Xo H• 1-45-4- loo �b6td fawn /) J �� /t / Q <br /> ��btii�t r't(/1(�t V �/ o <br /> Q <br /> TYPE OF PERMIT(S):DWELLING/BUILDING t/ GARAGE/ACCESSORY STRUCTURE ADDITION I � 0 <br /> Cr <br /> CL <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o' <br /> N <br /> STRUCTURE/ADDITION USE: (24 <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) 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 /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING- (AERIAL OR TOP VIEW) m <br /> O m` <br /> n a <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <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, <br /> STREAM OR RIVER. Z <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. I N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE `U q S <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z .. �I O <br /> CONDITIONS OF PERMIT: o I (� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT l <br /> ISSUANCE. (r\lyY <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. �J <br /> 6. <br /> 3F a M <br /> A C w w o S 3 <br /> 7. Z : <br /> o i � <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of m m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of i m 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- <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 admi m <br /> unty ordinances or other m <br /> authorized person to have access to the above described premises at any reasonabi a for tft pur n, <br /> SIGN HERE tF�""v"�' -fir C /Z//jY) i 1 <br /> m : <br /> (si stur of owne b Iding contractor) <br /> 2 9 <br /> ZONING ADMINISTRATOR � ? ,`• <br /> hVIHHfq dim <br /> _"'_�-_ :I`f/ N (.NO ,n ,0 O O <br /> TOWNSHIP PERMITS MAY BE RE QUI ER 0 il 0 0 00 0 0 <br /> 0000000 <br />