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oq-.l &''yip , <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator W o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> iA <br /> OWNER TELEPHONE U( m U1 <br /> HOME ADDRESS �r <br /> O <br /> V - <br /> EMERGENCY/FIRE <br /> NUMBER ROAD NAME E— pe J;IS LD 1,�e C7 " <br /> r� <br /> LEGAL DESCRIPTION(see tax receipt) —35 y <br /> e <br /> NG <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION c <br /> CL <br /> SANITARY PRIVY FILLI <br /> N <br /> G <br /> /GR <br /> A <br /> DINGCAMPING UNIT SUBDIVISION o'� '�•., <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR m C <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> M <br /> DIRECTIONS FOR PLOT PLAN DRAWING- (AERIAL OR TOP VIEW) 0 <br /> In Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO ca M3 <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER. c <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 -c- <br /> MUST BE SIGNED AND DATED BY THE OWNER. u v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE Cr. <br /> (1� <br /> ISSUED. ) <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> Cr <br /> CONDITIONS OF PERMIT: P _ <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. <br /> z - mm 0 a -0 <br /> s. 14' 3, <br /> .. <br /> it <br /> 7. c � �fP 1 <br /> y: A <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of my (9) ZS c p <br /> PP (� 9 Y ) Y <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of 'm C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize C m ; m <br /> that this information I am providing will be relied upon by the County of Bumett 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 administering county ordinances or other 2 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. m <br /> m : <br /> m : <br /> SIGN HERE `fl <br /> (signature <br /> \ of owner or building contactor) (date) <br /> ZONING ADMINISTRATOR J !Yl <br /> N N N N N N N <br /> N Vt O V•Vt O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />