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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> N O0 <br /> N <br /> OWNER JAM TELEPHONE Ell DL Nl TELEPHONE <br /> m <br /> �y• , / �l� I /� � ° O <br /> HOME ADDRESS <br /> —t—�— r M <br /> EMERGENCY/FIRE NUMBER �Q a 7 ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) 3 J� ` ` �v Il S/� I o <br /> 0 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE X ADDITION- <br /> SANITARY— <br /> DDITION SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ^ <br /> STRUCTURE/ADDITION USE: 9 <br /> (Home/Cabin; Comme al Business; Bedroom;Deck;etc.) m <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 fD v <br /> CL <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS (NB)AND INDICATE m n <br /> NORTH(N). IA ° <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, (X) Z <br /> STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. ° <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILD- O <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. ° <br /> o 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE q ° / <br /> ISSUED. °�. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> O <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. d, <br /> 4. <br /> 5. zvODr, oDom <br /> 6. C <br /> N N <br /> H m ° 7('a <br /> Z ; <br /> '< <br /> 7. = Cn : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G7 c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of a is <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- 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 'm <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized pens have access to th above described premises at any reasonable time for the purpose of inspection. _n <br /> G : <br /> / m : <br /> SIGN HERE nn,, <br /> (sig�ure of owner or building contra or) (date) Kl <br /> ZONING ADMINISTRATOR J FYI l <br /> f» f»d+N to cn <br /> � oci, �oo <br /> 0 0 0 0 0 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />