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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator O �o r o <br /> APPLICATION FOR LAND USE PERMITS <br /> o � <br /> OWNER 14/��I7(71717 � YION(�C� �� �� PH TELEPHONE -71 rj-3(l�rS18$ a <br /> HOME ADDRESS 5O Z V tc7S0 rj IN I 5-1-014o v <br /> EMERGENCY/FIRE NUMBER 71 S`3g(p"S j$$ ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) L.b j Ll($()1 1/, 47� [ �� L — �� ¢ o <br /> o <br /> CA � <br /> TYPE OF PERMIT(S): DWELLING/BUILDING X GARAGE/ACCESSORY STRUCTURE ADDITION ii <br /> n <br /> 5: <br /> N <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> / Q) <br /> �Q <br /> STRUCTURE/ADDITION USE: �)^i is U' <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 m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m IF <br /> 'p <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <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, o <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 S _ <br /> MUST BE SIGNED AND DATED BY THE OWNER. S. <br /> 0 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE Ct <br /> ISSUED. T <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: <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 /> PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. y <br /> A - m m Ota 0m <br /> a <br /> 3 a c E <br /> 6. g00N� m <br /> _or: m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ? d g C <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of n <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize v n e : m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 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 r d <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to h aMs,261fili above described premises at any reasonable time for the r ction. -n <br /> r m E <br /> SIGN HERE <br /> (si atur of owner o Ing contractor) ?�� ' (date) <br /> ZONING ADMINISTRATOR <br /> 1 I <br /> . tnwwwww� <br /> 0 0 0 <br /> TOWNSHIP PERMITS MAY BE RE �� 000000 0 0 <br /> 00 <br />