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6–n C" <br /> Burnett'+County 7410 Co. Rd.K, No. 102, Siren,WI 64872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS R r <br /> OWNER i� ka !G �� TELEPHONE �< o <br /> m <br /> � O <br /> HOME ADDRESS t 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> OA <br /> LEGAL DESCRIPTION(see tax receipt) — ` - 1` o) <br /> 0 <br /> e <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY ST UCTURE DDITION Cr <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> STRUCTURE/ADDITION USE: 1�1 ! <br /> (Home/C in;jornmercial 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. O <br /> w <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T <br /> '11 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 n <br /> NORTH 3. SHOW D M)ENSIONS 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, c <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. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 0 <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: U i <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT i 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 /> 5.6- ::SE�' Va r 0aV,>-4�5&3 -04r1MH <br /> H&M. <br /> gx <br /> 7. c 31Z <br /> _y M <br /> r 1` m <br /> C <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my �I ; ID <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of S� ? n P ; <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- d 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 p d <br /> providing in this application. I agee to permit county officials charged with administering county ordinances or other m i <br /> authorized person to have access t he abovqr1d4cribed1premisefat any reasonable time for the purpose of Inspection. -n <br /> CD : <br /> m <br /> SIGN H RE ` G�'—� <br /> (siignature of owner or building contractor) (date) <br /> — <br /> ZONING ADMINISTRATOR ZJ 1 no <br /> � <br /> �o•cNi+ poo <br /> 0000000 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />