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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator �Uj' o <br /> APPLICATION FOR LAND USE PERMITS a 4 <br /> r <br /> wN 0 <br /> C <br /> OWNERFo u, GG `' CC)U S�� TELEPHONE � - '�q m <br /> HOME ADDRESS G SA1� e� ?� 9 <br /> /� ,� m <br /> EMERGENCY/FIRE NUMBER S ,17 1 l� ROAD NAME 1 <br /> r <br /> LEGAL DESCRIPTION(see tax receipt) . — 33— (�—I c <br /> 0 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE DDITION c <br /> CL <br /> 5. <br /> SANITARY PRIVY FILLING/GRAD <br /> IN <br /> G—CAM)PING\'UNIT SUBDIVISION <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) yx <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR T <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O <br /> ^ Z ly <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). rA <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER. P <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. 64 <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. m o <br /> G <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE re ° <br /> ISSUED. g <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P ' <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT I <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. 2 <br /> �xq L7 ; <br /> 3n 'rF� <br /> 6. fe � –na,� .� <br /> � ? ItNC0 !" =m - <br /> 7 00 : a � 7g <br /> CO! m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ? ; ? ; ID <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of R , <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- O <br /> sue a permit. 1 further accept all liability which may be a result of the County of Burnett relying on this information I am m E E <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other E E <br /> authorized perscM to have access to ttke above described premises at any reasonable time for the purpose of Inspection. m <br /> SIGN HER n_�v_uti., _ 3 <br /> (sig-na'ttuiGCcure� ,neerrjor building contractor) (date) <br /> ZONING ADMINISTRATOR _ZT1 T I n V1 W H N 4` w <br /> N N NN O N° N <br /> fn N O <br /> TOWNSHIP PERMITS MAY BE REQUIRED c c 07c 00 00 <br />