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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator o 0 <br /> APPLICATION FOR LAND USE PERMITS 4 <br /> q o d <br /> OWNER TELEPHONE 6/ate s.ob o <br /> l d26h <br /> HOME ADDRESS p <br /> i 0 <br /> r m <br /> EMERGENCY/FIRE NUMBER ROAD NAME �� � � �•' / <br /> C ) 1 <br /> LEGAL DESCRIPTION(see tax receipt) S �1 y d <br /> TYPE OF PERMIT(S):DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION �N <br /> C <br /> Cr <br /> CL <br /> 5. <br /> SANITARY PRIVY FILLING/GRADINGc� v CAMPING UNIT SUBDIVISION 0' <br /> STRUCTURE/ADDITION USE: d �O r y y r W Iyy/yl SAO yo �( oP -� <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) 1 W <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR Sy� q <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 77 <br /> DIRECTIONS FOR PLOT PLAN D AWIN ' (AERIAL OR TOP VIEW) j)e�vd OT <br /> 1. ALL REQUIRED DIMENSIONSOR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. N 5 iz-as 7 dc <br /> n m R <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m 9 <br /> NORTH(N). C �- 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m e <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, <br /> STREAM OR RIVER. I c <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILD- Q�J <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 n Y <br /> MUST BE SIGNED AND DATED BY THE OWNER. c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE9 Rj <br /> ISSUED. 3 ° <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z i <br /> CONDITIONS OF PERMIT: <br /> t. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. ( �1 <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. 2 <br /> 6. a <br /> I MM <br /> 7. It <br /> w w o= 3 <br /> Zi !0 'fO 1 <br /> ° � � <br /> I declare that this application meludin an accompanyingschedule has been examined by me and to the best of my Cn p <br /> PP (� g Y ) <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of d . . . ID <br /> all information contained in this application(Including any accompanying schedule)and I further declare that 1 recognize m m <br /> her to is- <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whetG5 E p <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 <br /> 4 : : <br /> authorized person to hav access to the above describe p ises at any reasonable time for the plirpose of I <br /> m i <br /> m : <br /> SIGN HERE D-J <br /> (s a re of own o ilding c e (date) <br /> ZONING ADMINISTRATOR 9IwoI I ; <br /> H <br /> M HMM ri N+ <br /> i N N°1(J I <br /> ' t _ N N 0171 tn00 <br /> 0 0 0 0 0 0 0 <br /> TOWNSHIP PERMITS MAYBE REQUIRED '" 0 0 0 0 0 o c <br />